MEDICARE: JENNIFER MARIE CLOUD M.A., 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	SA8628	FL

General Provider Information

NPI Number	:	1992845408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE CLOUD M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	2424 MILL CREEK CRT.
Second Line	:	SUITE 1
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8301
Country	:	US
Telephone Number	:	850-656-1600
Fax Number	:	850-656-9200

Provider Business Practice Location Address
First Line	:	2424 MILLCREEK CRT.
Second Line	:	SUITE 1
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8301
Country	:	US
Telephone Number	:	850-656-1600
Fax Number	:	850-656-9200

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/09/2007

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Directions to “ JENNIFER MARIE CLOUD M.A., CCC-SLP” Practice Location

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