Provider Demographics
NPI:1669824413
Name:FERGUSON, JAMAL-KALEE SR (LBS)
Entity Type:Individual
Prefix:MR
First Name:JAMAL-KALEE
Middle Name:
Last Name:FERGUSON
Suffix:SR
Gender:M
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2402
Mailing Address - Country:US
Mailing Address - Phone:267-767-0662
Mailing Address - Fax:
Practice Address - Street 1:272 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2402
Practice Address - Country:US
Practice Address - Phone:267-767-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health