Healthcare Provider Details

I. General information

NPI: 1538022991
Provider Name (Legal Business Name): JENNIFER DORENE GELLER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W PLATT ST # A-112
TAMPA FL
33606-2292
US

IV. Provider business mailing address

301 W PLATT ST # A-112
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 818-523-4603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA23867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: