Provider Demographics
NPI:1619149200
Name:KLUSMAN, JEANNE L (M ED)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:KLUSMAN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CESERY BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-745-3070
Mailing Address - Fax:904-745-3085
Practice Address - Street 1:1100 CESERY BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5612
Practice Address - Country:US
Practice Address - Phone:904-745-3070
Practice Address - Fax:904-745-3085
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health