Healthcare Provider Details

I. General information

NPI: 1992426688
Provider Name (Legal Business Name): JENNIFER SUDONNA ELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 NW FLORIDA AVE
STUART FL
34994-9152
US

IV. Provider business mailing address

2750 NW FLORIDA AVE
STUART FL
34994-9152
US

V. Phone/Fax

Practice location:
  • Phone: 772-267-6367
  • Fax: 772-223-5829
Mailing address:
  • Phone: 772-267-6367
  • Fax: 772-223-5829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: