MEDICARE: JENNIFER CAREY 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	SA8515	FL

General Provider Information

NPI Number	:	1962760496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CAREY MS, CCC, SLP

Provider Business Mailing Address
First Line	:	256 NE SOLIDA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-8440
Country	:	US
Telephone Number	:	772-342-1238
Fax Number	:	772-461-9954

Provider Business Practice Location Address
First Line	:	7664 GERMANY CANAL RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34987-3300
Country	:	US
Telephone Number	:	772-216-4412
Fax Number	:	772-461-9954

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

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	05/03/2012

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