MEDICARE: JESSICA PIETRO 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	4502	SC

General Provider Information

NPI Number	:	1386970051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PIETRO SLP

Provider Business Mailing Address
First Line	:	1327 CENTER LAKE DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 CENTER LAKE DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7421
Country	:	US
Telephone Number	:	732-754-0222
Fax Number	:

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

Provider Enumeration Date	:	10/30/2009
Last Update Date	:	05/01/2013

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Directions to “ JESSICA PIETRO SLP” Practice Location

Language	Start Address	Practice Location

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