Provider Demographics
NPI:1407363039
Name:DUGUAY, JANE MARIE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:DUGUAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S PALMETTO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4923
Mailing Address - Country:US
Mailing Address - Phone:386-265-3789
Mailing Address - Fax:
Practice Address - Street 1:517 S PALMETTO AVE APT 1
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4923
Practice Address - Country:US
Practice Address - Phone:386-265-3789
Practice Address - Fax:386-265-3789
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician