MEDICARE: DYNAMICALLY SPEAKING

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	SP. 8750	OH

General Provider Information

NPI Number	:	1447588272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMICALLY SPEAKING

Provider Business Mailing Address
First Line	:	404 TERRACE LN BLDG 5
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3212
Country	:	US
Telephone Number	:	216-973-9268
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 TERRACE LN BLDG 5
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3212
Country	:	US
Telephone Number	:	216-973-9268
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MS. JOCQEELA ELAINE MCWHORTER
Credential	:	OHIO LICENSURE
Telephone Number	:	216-973-9268

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	12/07/2009

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Directions to “DYNAMICALLY SPEAKING ” Practice Location

Language	Start Address	Practice Location

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