MEDICARE: JESSICA MYERS 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	3553	OK

General Provider Information

NPI Number	:	1225363781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MYERS CCC-SLP

Provider Business Mailing Address
First Line	:	500 CENTRAL PARK DR
Second Line	:	# 322
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-1705
Country	:	US
Telephone Number	:	918-607-6756
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CENTRAL PARK DR
Second Line	:	# 322
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-1705
Country	:	US
Telephone Number	:	918-607-6756
Fax Number	:

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

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	10/15/2009

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Directions to “ JESSICA MYERS CCC-SLP” Practice Location

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