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NPI Code Detail

MEDICARE: JENNIFER WILSON

MEDICARE: JENNIFER WILSON
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
1235Z00000XSpeech-Language PathologistSZ5367FL

Other Identifiers

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

General Provider Information

NPI Number : 1508123084
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WILSON
Provider Business Mailing Address
First Line : 19001 SW 106TH AVE
Second Line :
City : CUTLER BAY
State : FL
Zip : 33157-7669
Country : US
Telephone Number : 305-235-0401
Fax Number :
Provider Business Practice Location Address
First Line : 19001 SW 106TH AVE
Second Line :
City : CUTLER BAY
State : FL
Zip : 33157-7669
Country : US
Telephone Number : 305-235-0401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2012
Last Update Date : 04/20/2012

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Directions to “ JENNIFER WILSON ” Practice Location

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