MEDICARE: JER-AYE GAU 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366771537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JER-AYE GAU M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	930 BUTTON ROCK DR UNIT B7
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80504-3323
Country	:	US
Telephone Number	:	720-988-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 N TAFT AVE STE 100
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-8307
Country	:	US
Telephone Number	:	970-663-3222
Fax Number	:

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	08/11/2011

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