MEDICARE: MRS. JESSICA L BRANDON CAGS

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	103TS0200X	School Psychologist	3126237	OH

General Provider Information

NPI Number	:	1457692832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA L BRANDON CAGS

Provider Business Mailing Address
First Line	:	4615 TOWER AVE
Second Line	:
City	:	SAINT BERNARD
State	:	OH
Zip	:	45217-1724
Country	:	US
Telephone Number	:	513-482-7105
Fax Number	:	513-641-4878

Provider Business Practice Location Address
First Line	:	4615 TOWER AVE
Second Line	:
City	:	SAINT BERNARD
State	:	OH
Zip	:	45217-1724
Country	:	US
Telephone Number	:	513-482-7105
Fax Number	:	513-641-4878

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

Provider Enumeration Date	:	03/08/2013
Last Update Date	:	09/19/2014

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