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NPI Code Detail

MEDICARE: JILLIAN LAUREN ZAK MA, CCC-SLP

MEDICARE: JILLIAN LAUREN ZAK 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
1235Z00000XSpeech-Language PathologistSP.10293OH

General Provider Information

NPI Number : 1942555933
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN LAUREN ZAK MA, CCC-SLP
Provider Business Mailing Address
First Line : 614 HUNTMERE DR
Second Line :
City : BAY VILLAGE
State : OH
Zip : 44140-2542
Country : US
Telephone Number : 248-425-3926
Fax Number :
Provider Business Practice Location Address
First Line : 1275 LAKESIDE AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-1129
Country : US
Telephone Number : 216-241-8230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2012
Last Update Date : 07/17/2012

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