MEDICARE: MS. ANNE PINKENBURG MS, 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	105471	TX

General Provider Information

NPI Number	:	1356755946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE PINKENBURG MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5624 FURSMAN AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76114-4512
Country	:	US
Telephone Number	:	817-205-3842
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 MANHATTAN BLVD STE 204
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76120-1210
Country	:	US
Telephone Number	:	817-207-1500
Fax Number	:	817-507-0702

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

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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