Provider Demographics
NPI:1992188676
Name:GAGE, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GAGE
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 1:4766 N ALBURNETT RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-9724
Mailing Address - Country:US
Mailing Address - Phone:319-721-4763
Mailing Address - Fax:
Practice Address - Street 1:3047 CENTER POINT RD NE STE B
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4064
Practice Address - Country:US
Practice Address - Phone:319-261-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000419106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist