MEDICARE: JESSICA KALUZNY 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	SLP000070	DC

General Provider Information

NPI Number	:	1669793881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KALUZNY CCC-SLP

Provider Business Mailing Address
First Line	:	922 MADISON ST NW
Second Line	:	#203
City	:	WASHINGTON
State	:	DC
Zip	:	20011-8215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	922 MADISON ST NW
Second Line	:	#203
City	:	WASHINGTON
State	:	DC
Zip	:	20011-8215
Country	:	US
Telephone Number	:	814-450-0373
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	10/21/2013

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Directions to “ JESSICA KALUZNY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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