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NPI Code Detail

MEDICARE: JENNIFER WANDRAS SLP

MEDICARE: JENNIFER WANDRAS 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
1235Z00000XSpeech-Language Pathologist41YS00523400NJ

General Provider Information

NPI Number : 1043565674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WANDRAS SLP
Provider Business Mailing Address
First Line : 31 CEDAR AVE APT 8
Second Line :
City : LONG BRANCH
State : NJ
Zip : 07740-5129
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 31 CEDAR AVE APT 8
Second Line :
City : LONG BRANCH
State : NJ
Zip : 07740-5129
Country : US
Telephone Number : 732-761-0088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2012
Last Update Date : 07/19/2012

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Directions to “ JENNIFER WANDRAS SLP” Practice Location

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