Provider Demographics
NPI:1942339288
Name:CHAPMAN, JENNIFER RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTH
Last Name:CHAPMAN
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 1:4310 MEDICAL PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3331
Mailing Address - Country:US
Mailing Address - Phone:512-323-0825
Mailing Address - Fax:
Practice Address - Street 1:4310 MEDICAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3331
Practice Address - Country:US
Practice Address - Phone:512-323-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0061LJOtherBCBSTX PROVIDER NUMBER
TX0061LJOtherBCBSTX PROVIDER NUMBER