Provider Demographics
NPI:1801939590
Name:WECKERLY, JILL ELIZABETH (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:WECKERLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2351 CARDINAL LN
Mailing Address - Street 2:ANNEX B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3743
Mailing Address - Country:US
Mailing Address - Phone:619-347-4496
Mailing Address - Fax:858-496-2116
Practice Address - Street 1:2351 CARDINAL LN
Practice Address - Street 2:ANNEX B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3743
Practice Address - Country:US
Practice Address - Phone:619-347-4496
Practice Address - Fax:858-496-2116
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 17507103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist