MEDICARE: MRS. KELLY RENEE SCHAEFER 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		MT

General Provider Information

NPI Number	:	1205054244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY RENEE SCHAEFER SLP

Provider Business Mailing Address
First Line	:	1931 SOUTH 3RD STREET W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801
Country	:	US
Telephone Number	:	406-829-6349
Fax Number	:	406-829-6349

Provider Business Practice Location Address
First Line	:	1931 SOUTH 3RD STREET W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801
Country	:	US
Telephone Number	:	406-829-6349
Fax Number	:	406-829-6349

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	09/24/2009

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