MEDICARE: JIL M GERTZ 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	SP117	NV

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	:	1538269451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIL M GERTZ MA/CCC-SLP

Provider Business Mailing Address
First Line	:	5552 S FORT APACHE RD
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7694
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:	702-399-8255

Provider Business Practice Location Address
First Line	:	5552 S FORT APACHE RD
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7694
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:	702-399-8255

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/11/2012

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