MEDICARE: JESSICA USRY

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	:	1043622376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA USRY

Provider Business Mailing Address
First Line	:	2321 CHAMPA ST
Second Line	:	APT 303
City	:	DENVER
State	:	CO
Zip	:	80205-2966
Country	:	US
Telephone Number	:	706-495-9685
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 CHAMPA ST
Second Line	:	APT 303
City	:	DENVER
State	:	CO
Zip	:	80205-2966
Country	:	US
Telephone Number	:	706-495-9685
Fax Number	:

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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Directions to “ JESSICA USRY ” Practice Location

Language	Start Address	Practice Location

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