MEDICARE: JACQUELIN JARVIS 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	22005771A	IN

General Provider Information

NPI Number	:	1477968162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELIN JARVIS CCC-SLP

Provider Business Mailing Address
First Line	:	2521 E MARKET ST
Second Line	:
City	:	NAPPANEE
State	:	IN
Zip	:	46550-9396
Country	:	US
Telephone Number	:	574-773-7733
Fax Number	:	574-773-7133

Provider Business Practice Location Address
First Line	:	2521 E MARKET ST
Second Line	:
City	:	NAPPANEE
State	:	IN
Zip	:	46550-9396
Country	:	US
Telephone Number	:	574-773-7733
Fax Number	:	574-773-7133

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

Provider Enumeration Date	:	06/22/2014
Last Update Date	:	06/22/2014

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Directions to “ JACQUELIN JARVIS CCC-SLP” Practice Location

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