MEDICARE: PENNY KAY FEDERSPIEL 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	115617	TX

General Provider Information

NPI Number	:	1568129526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY KAY FEDERSPIEL CCC-SLP

Provider Business Mailing Address
First Line	:	1404 CALICHE TRL
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-5898
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5585 CARUTH HAVEN LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-8157
Country	:	US
Telephone Number	:	214-587-8910
Fax Number	:

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

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	11/23/2021

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Directions to “ PENNY KAY FEDERSPIEL CCC-SLP” Practice Location

Language	Start Address	Practice Location

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