Provider Demographics
NPI:1720203771
Name:TISCHNER, JESSICA S (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:TISCHNER
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 1:2144 PAGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5952
Mailing Address - Country:US
Mailing Address - Phone:919-609-9812
Mailing Address - Fax:
Practice Address - Street 1:2144 PAGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5952
Practice Address - Country:US
Practice Address - Phone:919-609-9812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3246103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X, 103TH0004X, 103TB0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy