Provider Demographics
NPI:1912180589
Name:GAYLER, JENNIFER JOHNSON
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOHNSON
Last Name:GAYLER
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 1:6905 E WEDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2901
Mailing Address - Country:US
Mailing Address - Phone:954-816-0502
Mailing Address - Fax:
Practice Address - Street 1:14201 W SUNRISE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-756-2818
Practice Address - Fax:954-514-1126
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist