MEDICARE: JENNIFER SORIANO

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	114155	TX

General Provider Information

NPI Number	:	1508423237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SORIANO

Provider Business Mailing Address
First Line	:	120 W MAIN ST STE 210
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-4224
Country	:	US
Telephone Number	:	972-638-7286
Fax Number	:	972-499-1334

Provider Business Practice Location Address
First Line	:	5801 MARVIN D LOVE FWY STE 308E
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2388
Country	:	US
Telephone Number	:	972-638-7286
Fax Number	:	972-499-1334

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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Directions to “ JENNIFER SORIANO ” Practice Location

Language	Start Address	Practice Location

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