Provider Demographics
NPI:1679974877
Name:ACKRISH, JENNIFER ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELLEN
Last Name:ACKRISH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11295 NW 71ST CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3851
Mailing Address - Country:US
Mailing Address - Phone:561-299-0483
Mailing Address - Fax:954-566-1186
Practice Address - Street 1:11295 NW 71ST CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3851
Practice Address - Country:US
Practice Address - Phone:561-299-0483
Practice Address - Fax:954-566-1186
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical