MEDICARE: JANA MICHELLE BLEVINS 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	2449	KS
2	235Z00000X	Speech-Language Pathologist	2018013326	MO

General Provider Information

NPI Number	:	1942403738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA MICHELLE BLEVINS MS CCC-SLP

Provider Business Mailing Address
First Line	:	50495 E 100 RD
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-6073
Country	:	US
Telephone Number	:	191-392-7229
Fax Number	:

Provider Business Practice Location Address
First Line	:	50495 E 100 RD
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-6073
Country	:	US
Telephone Number	:	139-272-2979
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/22/2021

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