MEDICARE: MS. JESSICA L FALKIN MS, 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	017264-1	NY
2	235Z00000X	Speech-Language Pathologist	41YS00739600	NJ

General Provider Information

NPI Number	:	1851575104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA L FALKIN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	104 MOHAWK RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-3032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 MOHAWK RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-3032
Country	:	US
Telephone Number	:	908-358-4413
Fax Number	:

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	08/15/2013

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