MEDICARE: JESSICA SADA M.A. 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	SL01020	PA
2	235Z00000X	Speech-Language Pathologist	SA11919	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275821621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SADA M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	428 MUIR AVE
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-7486
Country	:	US
Telephone Number	:	570-956-5817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 18TH AVE N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3756
Country	:	US
Telephone Number	:	570-956-5817
Fax Number	:

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	12/12/2019

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Language	Start Address	Practice Location

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