Provider Demographics
NPI:1316342488
Name:JUNG, GINA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SW ARCHER RD APT M88
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3888
Mailing Address - Country:US
Mailing Address - Phone:813-817-1708
Mailing Address - Fax:
Practice Address - Street 1:4740 NW 39TH PL
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7226
Practice Address - Country:US
Practice Address - Phone:352-265-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist