MEDICARE: MARY JANE ZIEGEMEIER

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

General Provider Information

NPI Number	:	1669945853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE ZIEGEMEIER

Provider Business Mailing Address
First Line	:	4545 CENTRAL SCHOOL RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-7113
Country	:	US
Telephone Number	:	636-851-4067
Fax Number	:	636-805-4094

Provider Business Practice Location Address
First Line	:	2555 HACKMANN RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5452
Country	:	US
Telephone Number	:	636-851-6200
Fax Number	:	636-851-6202

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “ MARY JANE ZIEGEMEIER ” Practice Location

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