MEDICARE: MRS. CARLY JAHNER

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	2355A2700X	Audiology Assistant

General Provider Information

NPI Number	:	1033542048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLY JAHNER

Provider Business Mailing Address
First Line	:	1656 E SALTSAGE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-9420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1656 E SALTSAGE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-9420
Country	:	US
Telephone Number	:	218-556-3929
Fax Number	:

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

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	08/20/2013

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Directions to “ MRS. CARLY JAHNER ” Practice Location

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