MEDICARE: MRS. JESSICA STEFFES MAICKI M.A.

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

General Provider Information

NPI Number	:	1033417076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA STEFFES MAICKI M.A.

Provider Business Mailing Address
First Line	:	23825 COMMERCE PARK ROAD
Second Line	:	STE. B
City	:	BEACHWOOD
State	:	OH
Zip	:	44122
Country	:	US
Telephone Number	:	216-292-7370
Fax Number	:	216-292-7042

Provider Business Practice Location Address
First Line	:	23825 COMMERCE PARK
Second Line	:	STE. B
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5837
Country	:	US
Telephone Number	:	216-292-7370
Fax Number	:	216-292-7042

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

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	02/28/2011

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