Provider Demographics
NPI:1225312051
Name:GUEST, JENNIFER E (EDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:GUEST
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14216 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8546
Mailing Address - Country:US
Mailing Address - Phone:407-967-7312
Mailing Address - Fax:
Practice Address - Street 1:14216 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8546
Practice Address - Country:US
Practice Address - Phone:407-967-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool