MEDICARE: MS. JENNIFER MOSS MYDLARZ 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	SZ 5398	FL
2	235Z00000X	Speech-Language Pathologist	SA11744	FL

General Provider Information

NPI Number	:	1396031928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER MOSS MYDLARZ M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	4205 BLUFF HARBOR WAY
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8322
Country	:	US
Telephone Number	:	215-630-1217
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 BLUFF HARBOR WAY
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8322
Country	:	US
Telephone Number	:	215-630-1217
Fax Number	:

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	10/04/2024

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