Provider Demographics
NPI:1477041226
Name:GILBERT, JENNIFER (EDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GILBERT
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 1:63 STAFFORD INDIANS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-5803
Mailing Address - Country:US
Mailing Address - Phone:540-371-7200
Mailing Address - Fax:
Practice Address - Street 1:63 STAFFORD INDIANS LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-5803
Practice Address - Country:US
Practice Address - Phone:540-371-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool