MEDICARE: JENNIFER THIBODEAUX PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY9698	FL

General Provider Information

NPI Number	:	1013467919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER THIBODEAUX PH.D.

Provider Business Mailing Address
First Line	:	3000 GULF TO BAY BLVD STE 300
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4304
Country	:	US
Telephone Number	:	727-610-2395
Fax Number	:	727-933-0399

Provider Business Practice Location Address
First Line	:	3000 GULF TO BAY BLVD STE 300
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4304
Country	:	US
Telephone Number	:	727-222-5821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	12/20/2025

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