Provider Demographics
NPI:1750039418
Name:SPEGAL, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:SPEGAL
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 1:7611 EARLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7137
Mailing Address - Country:US
Mailing Address - Phone:352-978-7841
Mailing Address - Fax:
Practice Address - Street 1:13350 W COLONIAL DR STE 340
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3977
Practice Address - Country:US
Practice Address - Phone:407-654-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW18428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health