Provider Demographics
NPI:1609035922
Name:GILSON, JENNIFER L (EDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GILSON
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 1:18233 W EAST WIND AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-5062
Mailing Address - Country:US
Mailing Address - Phone:623-693-1451
Mailing Address - Fax:
Practice Address - Street 1:3921 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-1801
Practice Address - Country:US
Practice Address - Phone:602-764-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool