MEDICARE: MISS JODI LEBRUN 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

General Provider Information

NPI Number	:	1285917229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JODI LEBRUN SLP

Provider Business Mailing Address
First Line	:	995 HUMBOLDT ST APT 307
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3553
Country	:	US
Telephone Number	:	406-860-4088
Fax Number	:

Provider Business Practice Location Address
First Line	:	995 HUMBOLDT ST APT 307
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3553
Country	:	US
Telephone Number	:	406-860-4088
Fax Number	:

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

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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Directions to “ MISS JODI LEBRUN SLP” Practice Location

Language	Start Address	Practice Location

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