Provider Demographics
NPI:1942473517
Name:GALE, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 PROSPECTOR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7211
Mailing Address - Country:US
Mailing Address - Phone:435-645-9240
Mailing Address - Fax:435-645-9237
Practice Address - Street 1:1910 PROSPECTOR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7211
Practice Address - Country:US
Practice Address - Phone:435-645-9240
Practice Address - Fax:435-645-9237
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377761-2501103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist