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General NPI Number Information
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NPI Number | 1194032292
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Entity Type | Organization
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Legal Business Name | JENNIE L. ROBB, PH.D., PLLC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 9070 58TH DR E STE 102
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City | BRADENTON
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State | FL
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Zip | 34202-6110
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Country | US
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Telephone | 941-320-6320
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Fax | 941-753-5969
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Provider Business Mailing Address
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Address Line | 9070 58TH DR E STE 102
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City | BRADENTON
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State | FL
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Zip | 34202-6110
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Country | US
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Telephone | 941-320-6320
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Fax | 941-753-5969
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Authorized Official
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Title or Position | PSYCHOLOGIST/CEO
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Name | DR. JENNIE L. ROBB
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Credential | PH.D.
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Telephone | 941-320-6320
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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 | PY6351
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License Number State | FL
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