Basic Information
| Provider Information | |||||||||
| NPI: | 1629307848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGETTS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH. D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10181 NW 32ND TER | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331725914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973863 | ||||||||
| Practice Location | |||||||||
| Address1: | 10181 NW 32ND TER | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331725914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2009 | ||||||||
| LastUpdateDate: | 12/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-04-1991 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.