MEDICARE: JESSICA GABRIELLE PEPPE M.S., 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	018179	NY

General Provider Information

NPI Number	:	1164667754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GABRIELLE PEPPE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1744 WEST GENESEE STREET
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13204
Country	:	US
Telephone Number	:	315-468-3414
Fax Number	:	315-468-2089

Provider Business Practice Location Address
First Line	:	1744 WEST GENESEE STREET
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13204
Country	:	US
Telephone Number	:	315-468-3414
Fax Number	:	315-468-2089

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

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	12/10/2008

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