MEDICARE: MRS. JENNIFER REGNERY REEDER MS CCC-SLP CERT. AVT

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	15445	CA

General Provider Information

NPI Number	:	1518116367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER REGNERY REEDER MS CCC-SLP CERT. AVT

Provider Business Mailing Address
First Line	:	3668 SAN ANSELINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2701
Country	:	US
Telephone Number	:	562-212-9625
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 WOODRUFF AVE
Second Line	:	SUITE 211
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2143
Country	:	US
Telephone Number	:	562-354-6043
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/04/2014

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