MEDICARE: JERICA JAEL COX

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	105072	TX

General Provider Information

NPI Number	:	1164905808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERICA JAEL COX

Provider Business Mailing Address
First Line	:	4200 LIVE OAK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 LIVE OAK
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-7521
Country	:	US
Telephone Number	:	214-821-0050
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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Directions to “ JERICA JAEL COX ” Practice Location

Language	Start Address	Practice Location

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