MEDICARE: MRS. JILL CATHERINE MCQUERRY M.A. 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	SP10684	OH

General Provider Information

NPI Number	:	1821575291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL CATHERINE MCQUERRY M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	710 SEASONS PASS DR
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-4794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 DENISON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-2945
Country	:	US
Telephone Number	:	216-598-1789
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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