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General NPI Number Information
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NPI Number | 1194339994
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Entity Type | Individual
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Provider Name | JENNY GAMBLE SSP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 33 KNIGHT BOXX RD # 2
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City | ORANGE PARK
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State | FL
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Zip | 32065-7305
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Country | US
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Telephone | 904-385-9310
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Fax |
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Provider Business Mailing Address
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Address Line | 2613 RIDGECREST AVE
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City | ORANGE PARK
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State | FL
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Zip | 32065-6221
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Country | US
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Telephone | 904-635-3635
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS1448
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License Number State | FL
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