MEDICARE: FONDA KIRCHNER

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	SP.4279	OH

General Provider Information

NPI Number	:	1326445990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FONDA KIRCHNER

Provider Business Mailing Address
First Line	:	7465 BEACH RD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9287
Country	:	US
Telephone Number	:	330-618-6975
Fax Number	:

Provider Business Practice Location Address
First Line	:	7465 BEACH RD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9287
Country	:	US
Telephone Number	:	330-618-6975
Fax Number	:

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

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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Directions to “ FONDA KIRCHNER ” Practice Location

Language	Start Address	Practice Location

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