Provider Demographics
NPI:1740608728
Name:JACKSON, CORRIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:CORRIE
Other - Middle Name:L
Other - Last Name:SCHOFFSTALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 RUMFORD CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1773
Mailing Address - Country:US
Mailing Address - Phone:412-841-2833
Mailing Address - Fax:
Practice Address - Street 1:4 TERRY DR
Practice Address - Street 2:SUITE 11
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1838
Practice Address - Country:US
Practice Address - Phone:267-454-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist