MEDICARE: JENNIFER KOGAN MS, 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	41YS01156400	NJ

General Provider Information

NPI Number	:	1598532210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KOGAN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	430 GAMBOCZ CT
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2168
Country	:	US
Telephone Number	:	732-690-0613
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 GAMBOCZ CT
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2168
Country	:	US
Telephone Number	:	732-690-0613
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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