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NPI Code Detail

MEDICARE: JACQUELINE GAJUS LSP. ED.S., MS

MEDICARE:   JACQUELINE  GAJUS  LSP. ED.S., MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool PsychologistLSP.01118OH

General Provider Information

NPI Number : 1669342648
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE GAJUS LSP. ED.S., MS
Provider Business Mailing Address
First Line : 3726 WOODLAND AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45209-2221
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3726 WOODLAND AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45209-2221
Country : US
Telephone Number : 513-289-4116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2025
Last Update Date : 11/06/2025

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Directions to “ JACQUELINE GAJUS LSP. ED.S., MS” Practice Location

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