Provider Demographics
NPI:1912569617
Name:FORRESTER, JENNIFER GRACE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GRACE
Last Name:FORRESTER
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 1:2990 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6066
Mailing Address - Country:US
Mailing Address - Phone:925-519-5037
Mailing Address - Fax:
Practice Address - Street 1:2990 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6066
Practice Address - Country:US
Practice Address - Phone:469-403-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11111103G00000X
TX39270103G00000X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist