MEDICARE: JESSICA KARP M.S. ED

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	8304	NC

General Provider Information

NPI Number	:	1861631749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KARP M.S. ED

Provider Business Mailing Address
First Line	:	11020 FEATHERBROOK RD
Second Line	:	APT 2B
City	:	CHARLOTTE
State	:	NC
Zip	:	28262
Country	:	US
Telephone Number	:	518-339-9787
Fax Number	:

Provider Business Practice Location Address
First Line	:	11020 FEATHERBROOK RD
Second Line	:	APT 2B
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-7749
Country	:	US
Telephone Number	:	518-339-9787
Fax Number	:

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

Provider Enumeration Date	:	02/17/2009
Last Update Date	:	02/17/2009

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