MEDICARE: MRS. JENNIFER ACKETT 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	SA3519	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679770044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ACKETT CCC-SLP

Provider Business Mailing Address
First Line	:	1601 W TIMBERLANE DR
Second Line	:	STE 800
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0959
Country	:	US
Telephone Number	:	813-707-9362
Fax Number	:	813-443-8084

Provider Business Practice Location Address
First Line	:	1601 W TIMBERLANE DR
Second Line	:	STE 800
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0959
Country	:	US
Telephone Number	:	813-707-9362
Fax Number	:	813-443-8084

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	08/02/2012

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