MEDICARE: JENNY ELLISON M.S., 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	2363	AL

General Provider Information

NPI Number	:	1114493863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY ELLISON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2094 CHELSEA RIDGE DR
Second Line	:
City	:	COLUMBIANA
State	:	AL
Zip	:	35051-3380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ONE NINETEEN BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-7236
Country	:	US
Telephone Number	:	800-401-6335
Fax Number	:

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

Provider Enumeration Date	:	10/21/2018
Last Update Date	:	10/21/2018

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Directions to “ JENNY ELLISON M.S., CCC-SLP” Practice Location

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