MEDICARE: MRS. JENNIFER PHILLIPS 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	SA 5921	FL

General Provider Information

NPI Number	:	1063895795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER PHILLIPS CCC-SLP

Provider Business Mailing Address
First Line	:	7017 CITRUS POINT CT
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-7500
Country	:	US
Telephone Number	:	407-702-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	7017 CITRUS POINT CT
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-7500
Country	:	US
Telephone Number	:	407-702-3025
Fax Number	:

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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