MEDICARE: JESSICA PERRIN M.S., CF/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

General Provider Information

NPI Number	:	1518474337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PERRIN M.S., CF/SLP

Provider Business Mailing Address
First Line	:	520 SE 5TH AVE APT 3404
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2960
Country	:	US
Telephone Number	:	561-267-9905
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 SE 5TH AVE APT 3404
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2960
Country	:	US
Telephone Number	:	561-267-9905
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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