Individual
JACQUELYNN NICHOLE STANSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1877 ELKINS POINT DR, MELBOURNE, FL 32935-4762
(208) 991-8952
Mailing address
1160 LUMINARY CIR UNIT 101, MELBOURNE, FL 32901-7834
(208) 991-8952
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
03/19/2019
Last updated
01/02/2020
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