MEDICARE: MRS. JAN ELIZABETH MICHAELREE MS, CCC/SLP-L

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	2012026102	MO

General Provider Information

NPI Number	:	1821345232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAN ELIZABETH MICHAELREE MS, CCC/SLP-L

Provider Business Mailing Address
First Line	:	4725 CLEARWOOD LN
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-2301
Country	:	US
Telephone Number	:	314-435-4085
Fax Number	:

Provider Business Practice Location Address
First Line	:	4725 CLEARWOOD LN
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-2301
Country	:	US
Telephone Number	:	314-435-4085
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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Directions to “ MRS. JAN ELIZABETH MICHAELREE MS, CCC/SLP-L” Practice Location

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