MEDICARE: JENNIFER RUTH ELTON 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	12017360	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4600414	OTHER	MN	MEDICA
3	4DY03SP	OTHER	MN	BCBS
4	HP34980	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1205892577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RUTH ELTON CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 11
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-0011
Country	:	US
Telephone Number	:	612-308-6132
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 CAROL LN
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-4705
Country	:	US
Telephone Number	:	612-308-6132
Fax Number	:	651-414-9339

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	11/08/2011

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Directions to “ JENNIFER RUTH ELTON CCC-SLP” Practice Location

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