Provider Demographics
NPI:1861473449
Name:STONE, JENNIFER ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:STONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5154 STAGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3118
Mailing Address - Country:US
Mailing Address - Phone:901-372-9133
Mailing Address - Fax:901-372-1015
Practice Address - Street 1:1000 S COOPER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5611
Practice Address - Country:US
Practice Address - Phone:901-361-0169
Practice Address - Fax:901-844-4357
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26356103TC0700X
MD02369103TC0700X
PAPS004731L103TC0700X
TNP000002647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical