MEDICARE: PAULINE L KUNTZ 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	000368	GA

General Provider Information

NPI Number	:	1538163167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE L KUNTZ SLP

Provider Business Mailing Address
First Line	:	2160 SMYRNA RIDGE CT SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-6200
Country	:	US
Telephone Number	:	770-483-1083
Fax Number	:	770-483-1083

Provider Business Practice Location Address
First Line	:	2160 SMYRNA RIDGE CT SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-6200
Country	:	US
Telephone Number	:	770-483-1083
Fax Number	:	770-483-1083

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/09/2007

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