| Doctor Name: | JOLEEN FERNALD |
| NPI Number: | 1245367069 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SA12821 |
| Business Practice Address: | 1816 Health Care Dr Trinity, FL - 346555362 |
| Business Phone Number: | 6034987825 |
| Business Fax Number: | 8885017019 |
| Mailing Address: | 1427 Kinsmere Dr, TRINITY |
| State: | FL |
| Postal Code: | 346554525 |
| Phone Number: | 6034987825 |
| Fax Number: | 8885017019 |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 09/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA12821 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |