Healthcare Provider Details

I. General information

NPI: 1154723765
Provider Name (Legal Business Name): JORELLE LAAKSO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 SW 13TH ST
GAINESVILLE FL
32608-3513
US

IV. Provider business mailing address

4001 SW 13TH STREET
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5500
  • Fax:
Mailing address:
  • Phone: 352-265-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: