MEDICARE: MS. JENNIFER LYNN FORD M.A. 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	2002016785	MO
2	235Z00000X	Speech-Language Pathologist	2148	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12051977	OTHER		ASHA

General Provider Information

NPI Number	:	1306847801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LYNN FORD M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	5520 COLLEGE BLVD
Second Line	:	SUITE 370
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1630
Country	:	US
Telephone Number	:	913-696-8844
Fax Number	:	913-696-8855

Provider Business Practice Location Address
First Line	:	5520 COLLEGE BLVD
Second Line	:	SUITE 370
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1630
Country	:	US
Telephone Number	:	913-696-8844
Fax Number	:	913-696-8855

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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Directions to “ MS. JENNIFER LYNN FORD M.A. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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