MEDICARE: JENNIFER MARIE NEALIS M.A. 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	SA12476	FL
2	235Z00000X	Speech-Language Pathologist	SZ5770	FL
3	235Z00000X	Speech-Language Pathologist	SLP.0004452	CO

General Provider Information

NPI Number	:	1831450055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE NEALIS M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	1826 DEEP WOODS LN
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2370
Country	:	US
Telephone Number	:	727-560-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1826 DEEP WOODS LN
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2370
Country	:	US
Telephone Number	:	727-560-8758
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	04/13/2022

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Directions to “ JENNIFER MARIE NEALIS M.A. CCC-SLP” Practice Location

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