Provider Demographics
NPI:1053403071
Name:JAGIELKO, JENNIFER RUTHERFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTHERFORD
Last Name:JAGIELKO
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 1:107 S SHEPPARD ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5266
Mailing Address - Country:US
Mailing Address - Phone:512-255-9554
Mailing Address - Fax:512-255-9342
Practice Address - Street 1:107 S SHEPPARD ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5266
Practice Address - Country:US
Practice Address - Phone:512-255-9554
Practice Address - Fax:512-255-9342
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32581103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist