MEDICARE: MRS. JESSICA JANELLE ANSON M.S. 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	146007741	IL
2	235Z00000X	Speech-Language Pathologist	8153	NC

General Provider Information

NPI Number	:	1770606188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA JANELLE ANSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2022 WEDDINGTON LAKE DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28104-8743
Country	:	US
Telephone Number	:	704-846-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2022 WEDDINGTON LAKE DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28104-8743
Country	:	US
Telephone Number	:	704-846-2773
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	10/30/2008

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Directions to “ MRS. JESSICA JANELLE ANSON M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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