MEDICARE: MRS. JENNIFER ALLLISON REIDENBACH MSR, 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	3695	SC

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	:	1780647610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ALLLISON REIDENBACH MSR, CCC-SLP

Provider Business Mailing Address
First Line	:	1233 BEN SAWYER BLVD
Second Line	:	SUITE 500
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4577
Country	:	US
Telephone Number	:	843-697-0396
Fax Number	:	864-640-8011

Provider Business Practice Location Address
First Line	:	1233 BEN SAWYER BLVD
Second Line	:	SUITE 500
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4577
Country	:	US
Telephone Number	:	843-697-0396
Fax Number	:	864-640-8011

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	10/01/2008

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Directions to “ MRS. JENNIFER ALLLISON REIDENBACH MSR, CCC-SLP” Practice Location

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