Provider Demographics
NPI:1497547681
Name:PAIGE, JENNIFER M (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PAIGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHELLEY RENEE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7373
Mailing Address - Country:US
Mailing Address - Phone:256-453-5383
Mailing Address - Fax:256-453-5383
Practice Address - Street 1:5118 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5720
Practice Address - Country:US
Practice Address - Phone:901-528-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical