Healthcare Provider Details

I. General information

NPI: 1174440408
Provider Name (Legal Business Name): JACOB CALLAWAY STEGGERDA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAKE STEGGERDA PHD

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 CENTER DR
GAINESVILLE FL
32611-2107
US

IV. Provider business mailing address

3380 NW 37TH ST
GAINESVILLE FL
32605-2043
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6617
  • Fax:
Mailing address:
  • Phone: 913-907-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY13116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: