Healthcare Provider Details

I. General information

NPI: 1770925802
Provider Name (Legal Business Name): JENNIFER STAPLE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KLEINFELDER M.A.

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3763 EVANS AVE
FORT MYERS FL
33901
US

IV. Provider business mailing address

3763 EVANS AVE
FORT MYERS FL
33901-9302
US

V. Phone/Fax

Practice location:
  • Phone: 239-332-6937
  • Fax: 239-332-0287
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: