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General NPI Number Information
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NPI Number | 1174734073
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Entity Type | Individual
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Provider Name | JANE ELLEN ECHTERLING PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NORTHEAST FLORIDA STATE HOSPITAL 7487 S. STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063
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Country | US
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Telephone | 904-259-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 5117 NW 27TH AVE
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City | GAINESVILLE
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State | FL
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Zip | 32606-6414
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Country | US
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Telephone | 352-377-6084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6778
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License Number State | FL
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