MEDICARE: MISS JENNIFER MARIE TRABULSI M.S. 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	6980	NC

General Provider Information

NPI Number	:	1669462495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNIFER MARIE TRABULSI M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	7609 ELLIOTT DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-4003
Country	:	US
Telephone Number	:	919-239-0953
Fax Number	:

Provider Business Practice Location Address
First Line	:	7609 ELLIOTT DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-4003
Country	:	US
Telephone Number	:	919-239-0953
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	01/13/2014

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