MEDICARE: MRS. LISA SHERRILL JENKINS 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	S3419	MS

General Provider Information

NPI Number	:	1578826830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA SHERRILL JENKINS SLP

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-0428
Country	:	US
Telephone Number	:	716-662-4955
Fax Number	:

Provider Business Practice Location Address
First Line	:	4036 HIGHWAY 8
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-8551
Country	:	US
Telephone Number	:	662-843-4014
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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