Healthcare Provider Details

I. General information

NPI: 1336604347
Provider Name (Legal Business Name): ALLISON GENDREAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 ATLANTIC BLVD STE 200
JACKSONVILLE FL
32225-0102
US

IV. Provider business mailing address

311 EAST COLLEGE STREET
MOUNT VERNON GA
30445
US

V. Phone/Fax

Practice location:
  • Phone: 904-491-2111
  • Fax: 904-512-0613
Mailing address:
  • Phone: 904-415-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: