MEDICARE: JENNIFER VANE, PH.D., P.C.

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	103T00000X	Psychologist	32530	TX

General Provider Information

NPI Number	:	1134225972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER VANE, PH.D., P.C.

Provider Business Mailing Address
First Line	:	6704 VALBURN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-1802
Country	:	US
Telephone Number	:	512-608-4079
Fax Number	:

Provider Business Practice Location Address
First Line	:	4409 MEDICAL PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3313
Country	:	US
Telephone Number	:	512-495-9556
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT LICENSED PSYCHOLOGIST
Name	:	DR. JENNIFER VANE MELROSE
Credential	:	PH.D.
Telephone Number	:	512-495-9556

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/06/2008

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