MEDICARE: JENNIFER BLEY

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	11483	CA

General Provider Information

NPI Number	:	1265690796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BLEY

Provider Business Mailing Address
First Line	:	74655 MEXICALI ROSE
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-4105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	74655 MEXICALI ROSE
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-4105
Country	:	US
Telephone Number	:	760-218-0013
Fax Number	:

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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Directions to “ JENNIFER BLEY ” Practice Location

Language	Start Address	Practice Location

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