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NPI Code Detail

MEDICARE: KELLY RENEE PEIFER SHENK CCC-SLP

MEDICARE: KELLY RENEE PEIFER SHENK 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 PathologistSL007495PA

General Provider Information

NPI Number : 1093014011
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RENEE PEIFER SHENK CCC-SLP
Provider Business Mailing Address
First Line : 973 GAULT RD
Second Line :
City : NEW HOLLAND
State : PA
Zip : 17557-9011
Country : US
Telephone Number : 717-468-1570
Fax Number :
Provider Business Practice Location Address
First Line : 101 N COLLEGE AVE
Second Line :
City : ANNVILLE
State : PA
Zip : 17003-1400
Country : US
Telephone Number : 717-867-6705
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2011
Last Update Date : 11/11/2022

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