Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 020878 | NY |
N | 103TC0700X | Clinical Psychologist | 020878 | NY |
N | 103G00000X | Clinical Psychologist | 020878 | NY |
N | 103TC0700X | Clinical Psychologist | 020878 | NY |
Y | 103G00000X | Clinical Psychologist | 071009641 | IL |
Y | 103TC0700X | Clinical Psychologist | 071009641 | IL |
NPI | 1003217571 |
---|---|
Provider Name | Jessica Paxton |
First Address | Orland Park, IL 60462-1940 |
Second Address | Orland Park, IL 60462-1940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 04/12/2018 |