MEDICARE: JENNIFER Z MATHIS 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	5494	NC

General Provider Information

NPI Number	:	1346513926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER Z MATHIS M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	210 DAY BREAK DR
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-6354
Country	:	US
Telephone Number	:	336-880-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	5603B W FRIENDLY AVE # 274
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-4213
Country	:	US
Telephone Number	:	336-790-0271
Fax Number	:	336-740-9099

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

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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