Healthcare Provider Details

I. General information

NPI: 1891639720
Provider Name (Legal Business Name): JENNIFER MCFADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S FISKE BLVD STE 201
ROCKLEDGE FL
32955-3007
US

IV. Provider business mailing address

7667 N WICKHAM RD APT 223
MELBOURNE FL
32940-7928
US

V. Phone/Fax

Practice location:
  • Phone: 321-634-3688
  • Fax: 321-634-3688
Mailing address:
  • Phone: 402-212-4816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: