Healthcare Provider Details

I. General information

NPI: 1912168170
Provider Name (Legal Business Name): JENNIFER GOLDSTEIN GELB M. S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTH BLVD W SUITE D
LEESBURG FL
34748-5063
US

IV. Provider business mailing address

600 NORTH BLVD W SUITE D
LEESBURG FL
34748-5063
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-6636
  • Fax: 352-787-4522
Mailing address:
  • Phone: 352-728-6636
  • Fax: 352-787-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: