MEDICARE: JENNIFER AUSTIN M.S, 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	SP 21258	CA

General Provider Information

NPI Number	:	1407206006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AUSTIN M.S, CCC-SLP

Provider Business Mailing Address
First Line	:	3969 ALLA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4113
Country	:	US
Telephone Number	:	310-729-1593
Fax Number	:

Provider Business Practice Location Address
First Line	:	3969 ALLA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4113
Country	:	US
Telephone Number	:	310-729-1593
Fax Number	:

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

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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