MEDICARE: ELIZABETH ANNE HENNESSEY M.S. CF-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	118384	TX

General Provider Information

NPI Number	:	1245801893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE HENNESSEY M.S. CF-SLP

Provider Business Mailing Address
First Line	:	3711 MEDICAL DR APT 323
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2194
Country	:	US
Telephone Number	:	210-510-8919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 MEDICAL DR APT 323
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2194
Country	:	US
Telephone Number	:	210-510-8919
Fax Number	:

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

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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Directions to “ ELIZABETH ANNE HENNESSEY M.S. CF-SLP” Practice Location

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