MEDICARE: MRS. JENNA BREWER-ENSZ 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	3632	OK

General Provider Information

NPI Number	:	1730392291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA BREWER-ENSZ M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1155 BAILEY CIR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-9746
Country	:	US
Telephone Number	:	405-323-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 BAILEY CIR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-9746
Country	:	US
Telephone Number	:	405-323-4448
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	09/29/2014

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