MEDICARE: JILLIAN ANDRYSIAK 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	7101008856	MI

General Provider Information

NPI Number	:	1205687704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN ANDRYSIAK MS, CCC-SLP

Provider Business Mailing Address
First Line	:	202 W SHIAWASSEE AVE # 114
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2093
Country	:	US
Telephone Number	:	248-780-9030
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 W SHIAWASSEE AVE # 114
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2093
Country	:	US
Telephone Number	:	248-780-9030
Fax Number	:

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

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	03/10/2026

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