MEDICARE: JOANNA BESS JACOBITTI MA,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	6965	NC

General Provider Information

NPI Number	:	1477759033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA BESS JACOBITTI MA,CCC,SLP

Provider Business Mailing Address
First Line	:	5113 GLENBRIER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-4440
Country	:	US
Telephone Number	:	704-654-9354
Fax Number	:

Provider Business Practice Location Address
First Line	:	5113 GLENBRIER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-4440
Country	:	US
Telephone Number	:	704-654-9354
Fax Number	:

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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