MEDICARE: JENNY L FELTY

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

General Provider Information

NPI Number	:	1821264185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY L FELTY

Provider Business Mailing Address
First Line	:	11131 PAULTON RD
Second Line	:
City	:	PITTSBURG
State	:	IL
Zip	:	62974-1709
Country	:	US
Telephone Number	:	618-922-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	11131 PAULTON RD
Second Line	:
City	:	PITTSBURG
State	:	IL
Zip	:	62974-1709
Country	:	US
Telephone Number	:	618-922-0717
Fax Number	:

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	06/17/2008

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Directions to “ JENNY L FELTY ” Practice Location

Language	Start Address	Practice Location

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