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NPI Code Detail

MEDICARE: MRS. JENNIFER RADOSEVIC MA, CCC-SP

MEDICARE: MRS. JENNIFER RADOSEVIC MA, CCC-SP
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 PathologistSP3629OH

General Provider Information

NPI Number : 1861810616
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER RADOSEVIC MA, CCC-SP
Provider Business Mailing Address
First Line : 2410 MASSILLON RD
Second Line :
City : AKRON
State : OH
Zip : 44312-4258
Country : US
Telephone Number : 330-798-1008
Fax Number : 330-798-1168
Provider Business Practice Location Address
First Line : 3258 NIDOVER DR
Second Line :
City : AKRON
State : OH
Zip : 44312-4628
Country : US
Telephone Number : 330-798-1008
Fax Number : 330-798-1168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2014
Last Update Date : 03/30/2014

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Directions to “ MRS. JENNIFER RADOSEVIC MA, CCC-SP” Practice Location

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