MEDICARE: GILLIAN ALEXIS POWELL

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	SL013769	PA

General Provider Information

NPI Number	:	1962991794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN ALEXIS POWELL

Provider Business Mailing Address
First Line	:	2517 E GORDON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3622
Country	:	US
Telephone Number	:	609-513-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 E GORDON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3622
Country	:	US
Telephone Number	:	609-513-0283
Fax Number	:

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

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	05/07/2018

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Directions to “ GILLIAN ALEXIS POWELL ” Practice Location

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