MEDICARE: MRS. JENNIFER ZAGOREN WALTERS 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	SA5408	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	:	1417160193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ZAGOREN WALTERS M.A., CCC,SLP

Provider Business Mailing Address
First Line	:	3438 EHRLICH RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2502
Country	:	US
Telephone Number	:	813-264-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 N ARMENIA AVE
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33603-2626
Country	:	US
Telephone Number	:	813-870-0000
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/09/2007

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