Provider Demographics
NPI:1578733069
Name:JACKIE L. STANKIEWICZ, PH.D.
Entity Type:Organization
Organization Name:JACKIE L. STANKIEWICZ, PH.D.
Other - Org Name:PSYCHOLOGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-373-0033
Mailing Address - Street 1:5550 FRANKLIN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2129
Mailing Address - Country:US
Mailing Address - Phone:615-373-0033
Mailing Address - Fax:615-373-0073
Practice Address - Street 1:5550 FRANKLIN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2129
Practice Address - Country:US
Practice Address - Phone:615-373-0033
Practice Address - Fax:615-373-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2369103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty