| Doctor Name: | DR. CHERYLL ROTHERY-JACKSON |
| NPI Number: | 1174736979 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PS008803L |
| Business Practice Address: | 1016 Bethlehem Pike Erdenheim, PA - 190387703 |
| Business Phone Number: | 2152487023 |
| Business Fax Number: | 2157533619 |
| Mailing Address: | 9601 Germantown Ave, PHILADELPHIA |
| State: | PA |
| Postal Code: | 191182643 |
| Phone Number: | 2152487023 |
| Fax Number: | 2157533619 |
| NPI Enumeration Date: | 05/08/2007 |
| NPI Last Update Date: | 02/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS008803L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |