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NPI Code Detail

MEDICARE: MS. JERE AGNES EDEL SLP

MEDICARE: MS. JERE AGNES EDEL 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
1235Z00000XSpeech-Language Pathologist004374LPA

General Provider Information

NPI Number : 1922122787
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JERE AGNES EDEL SLP
Provider Business Mailing Address
First Line : PO BOX 785
Second Line :
City : BRADFORD
State : PA
Zip : 16701-0785
Country : US
Telephone Number : 814-837-6706
Fax Number : 814-837-9205
Provider Business Practice Location Address
First Line : 100 HIGH POINT DR
Second Line :
City : KANE
State : PA
Zip : 16735-9704
Country : US
Telephone Number : 814-837-6706
Fax Number : 814-837-9205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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Directions to “ MS. JERE AGNES EDEL SLP” Practice Location

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