MEDICARE: MS. JANICE S. HENSLEY SPEECH PATHOLOGY

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	3795	CA

General Provider Information

NPI Number	:	1215219225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE S. HENSLEY SPEECH PATHOLOGY

Provider Business Mailing Address
First Line	:	749 VISTA PACIFICA CIR
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3277
Country	:	US
Telephone Number	:	805-540-9024
Fax Number	:

Provider Business Practice Location Address
First Line	:	749 VISTA PACIFICA CIR
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3277
Country	:	US
Telephone Number	:	805-540-9024
Fax Number	:

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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