Provider Demographics
NPI:1558886366
Name:GRIDER, JESSICA GAIL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:GAIL
Last Name:GRIDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:GAIL
Other - Last Name:SAAVEDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22113 SW EDGEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-3301
Mailing Address - Country:US
Mailing Address - Phone:239-770-4297
Mailing Address - Fax:
Practice Address - Street 1:2479 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:407-657-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical