Provider Demographics
NPI:1134812233
Name:GAUDET, JAZMINE M
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:M
Last Name:GAUDET
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 1:1044 DEES DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7082
Mailing Address - Country:US
Mailing Address - Phone:718-790-5515
Mailing Address - Fax:
Practice Address - Street 1:170 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-2923
Practice Address - Country:US
Practice Address - Phone:718-790-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health