MEDICARE: JACQUELINE GAJUS LSP. ED.S., MS

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	103TS0200X	School Psychologist	LSP.01118	OH

General Provider Information

NPI Number	:	1669342648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE GAJUS LSP. ED.S., MS

Provider Business Mailing Address
First Line	:	3726 WOODLAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 WOODLAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2221
Country	:	US
Telephone Number	:	513-289-4116
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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