MEDICARE: JILL BANGS

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	7101002283

General Provider Information

NPI Number	:	1184352643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL BANGS

Provider Business Mailing Address
First Line	:	12725 MAHOGANY WAY
Second Line	:
City	:	DEWITT
State	:	MI
Zip	:	48820-7860
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16260 PARK LAKE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-9480
Country	:	US
Telephone Number	:	517-339-2322
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “ JILL BANGS ” Practice Location

Language	Start Address	Practice Location

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