MEDICARE: JILL REUTTER 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	SP. 7977	OH

General Provider Information

NPI Number	:	1124429550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL REUTTER MS CCC-SLP

Provider Business Mailing Address
First Line	:	11269 FOREMARK DR
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45241-2209
Country	:	US
Telephone Number	:	513-532-7381
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1507
Country	:	US
Telephone Number	:	513-532-7381
Fax Number	:

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

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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