MEDICARE: MRS. JENNIFER DYER MS, 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	110645	TX

General Provider Information

NPI Number	:	1730618919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER DYER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1511 KENDAL DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 KENDAL DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7606
Country	:	US
Telephone Number	:	501-626-8530
Fax Number	:	682-518-3419

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

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	06/09/2017

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Directions to “ MRS. JENNIFER DYER MS, CCC-SLP” Practice Location

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