MEDICARE: MS. JAMIE MARIE CULLEN MA,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	146.009542	IL

General Provider Information

NPI Number	:	1932446689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE MARIE CULLEN MA,CCC-SLP

Provider Business Mailing Address
First Line	:	1101 E. STATE STREET
Second Line	:	GENEVA NURSING AND REHABILITATION
City	:	GENEVA
State	:	IL
Zip	:	60134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 E STATE ST
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2438
Country	:	US
Telephone Number	:	630-397-5409
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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