MEDICARE: JENNIFER CULLER ALSDORF 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	SA 8232	FL
2	235Z00000X	Speech-Language Pathologist	SLP004307	GA

General Provider Information

NPI Number	:	1629002209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CULLER ALSDORF CCC-SLP

Provider Business Mailing Address
First Line	:	816 FORESTWOOD DR
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-7723
Country	:	US
Telephone Number	:	352-536-2561
Fax Number	:	407-264-6557

Provider Business Practice Location Address
First Line	:	816 FORESTWOOD DR
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-7723
Country	:	US
Telephone Number	:	352-536-2561
Fax Number	:	407-264-6557

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/09/2007

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Directions to “ JENNIFER CULLER ALSDORF CCC-SLP” Practice Location

Language	Start Address	Practice Location

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