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NPI Code Detail

MEDICARE: BRENNA JACOVETTI M.ED., CCC-SLP

MEDICARE: BRENNA JACOVETTI M.ED., 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 PathologistSLP012084GA

General Provider Information

NPI Number : 1780464818
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENNA JACOVETTI M.ED., CCC-SLP
Provider Business Mailing Address
First Line : 737 PEACHTREE HILLS CIR NE UNIT 737
Second Line :
City : ATLANTA
State : GA
Zip : 30305-4246
Country : US
Telephone Number : 770-876-7634
Fax Number :
Provider Business Practice Location Address
First Line : 737 PEACHTREE HILLS CIR NE UNIT 737
Second Line :
City : ATLANTA
State : GA
Zip : 30305-4246
Country : US
Telephone Number : 770-876-7634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2023
Last Update Date : 10/05/2023

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Directions to “ BRENNA JACOVETTI M.ED., CCC-SLP” Practice Location

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