MEDICARE: MRS. JODIE LYNN KERTZNER M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0097551	NY

General Provider Information

NPI Number	:	1003030446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODIE LYNN KERTZNER M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2442 KAYRON LN
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-2116
Country	:	US
Telephone Number	:	917-292-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	2442 KAYRON LN
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-2116
Country	:	US
Telephone Number	:	917-292-8228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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