Provider Demographics
NPI:1598789695
Name:JACKSON, JENNIFER MCCALL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MCCALL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3510 MONTLIMAR PLAZA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1746
Mailing Address - Country:US
Mailing Address - Phone:251-599-3728
Mailing Address - Fax:251-621-4078
Practice Address - Street 1:3510 MONTLIMAR PLAZA DR
Practice Address - Street 2:STE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1746
Practice Address - Country:US
Practice Address - Phone:251-599-3728
Practice Address - Fax:251-621-4078
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical