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NPI Code Detail

MEDICARE: JENNA DIANE RUNYAN MS,CCC-SLP

MEDICARE: JENNA DIANE RUNYAN 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
1235Z00000XSpeech-Language PathologistSLP-1482WV

General Provider Information

NPI Number : 1689095630
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA DIANE RUNYAN MS,CCC-SLP
Provider Business Mailing Address
First Line : PO BOX 450
Second Line :
City : SCOTT DEPOT
State : WV
Zip : 25560-0450
Country : US
Telephone Number : 304-760-6300
Fax Number : 304-201-5123
Provider Business Practice Location Address
First Line : 179 STATION PL
Second Line : SUITE 100
City : HURRICANE
State : WV
Zip : 25526-6578
Country : US
Telephone Number : 304-760-6300
Fax Number : 304-201-5123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2013
Last Update Date : 12/18/2013

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Directions to “ JENNA DIANE RUNYAN MS,CCC-SLP” Practice Location

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