MEDICARE: MRS. JAMIE LYNN ANKENY

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	17967	CA

General Provider Information

NPI Number	:	1689915225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNN ANKENY

Provider Business Mailing Address
First Line	:	17886 LA LIMA LN
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12062 VALLEY VIEW ST STE 137
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1741
Country	:	US
Telephone Number	:	714-901-1518
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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