MEDICARE: JILL FLORES 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	18974	TX

General Provider Information

NPI Number	:	1447762448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL FLORES M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	5328 DOVE CREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4403
Country	:	US
Telephone Number	:	817-368-6498
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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Directions to “ JILL FLORES M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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