Jacqueline J Head PSYD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1328 Issued in OR

Legal business name

JACQUELINE J HEAD PSYD PC

Practice address

22344 SW Main St
Sherwood, OR 97140-9416

Phone

(503) 625-2768

Fax

(503) 625-3768

NPI assigned

Jul 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacqueline Jean Head, PSYDNPI 1639153125

Title

President

Phone

(503) 625-2768

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline J Head, PSY.D. PC

  • Clinical Psychologist
  • Sherwood, OR
  • NPI 1639153125
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528086055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22344 SW MAIN ST",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409416",
            "telephone_number": "503-625-2768",
            "fax_number": "503-625-3768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22344 SW MAIN ST",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409416",
            "telephone_number": "503-625-2768",
            "fax_number": "503-625-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE J HEAD PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEAD",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-625-2768",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI, FOR IND. PROVIDER",
            "identifier": "1639153125",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debi Mari Huyssoon, DMD
• Sandra Susan Hyatt
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• Heather Ann Jackson
• William Joseph James, PSY.D.
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• Gary Jansen, D.C.
• Larry Edwin Raymond Jasper, PSYD
• Kortnie Johnson, SDH

• Clinical Psychologist in Sherwood, OR
• Providers in Sherwood, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.