Healthcare Provider Details

I. General information

NPI: 1790153757
Provider Name (Legal Business Name): JENNIFER SLUSARZ-CONROY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER VERONICA SLUSARZ

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 ATLANTIC BLVD STE 174
JACKSONVILLE FL
32225-6592
US

IV. Provider business mailing address

4895 CREEK BLUFF LN
MIDDLEBURG FL
32068-8732
US

V. Phone/Fax

Practice location:
  • Phone: 863-692-6802
  • Fax:
Mailing address:
  • Phone: 937-830-3017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7848
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: