MEDICARE: JANAYE ARLIVIA JASPER 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	SLP011653	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SLP011653	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1518530138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAYE ARLIVIA JASPER CCC-SLP

Provider Business Mailing Address
First Line	:	4287 HIGH PARK LN
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-7043
Country	:	US
Telephone Number	:	706-766-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	4287 HIGH PARK LN
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-7043
Country	:	US
Telephone Number	:	706-766-6605
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	09/16/2022

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Directions to “ JANAYE ARLIVIA JASPER CCC-SLP” Practice Location

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