Provider Demographics
NPI:1033280185
Name:JENNINGS, SUSAN MARIE (EDD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:REYNOLDS
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:1275 S PATRICK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-779-0213
Mailing Address - Fax:321-773-0497
Practice Address - Street 1:1275 S PATRICK DR
Practice Address - Street 2:SUITE C
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-779-0213
Practice Address - Fax:321-773-0497
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health