MEDICARE: MS. NENA H FENNELL MED.CCC-SLP L

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	SLP001029	GA

General Provider Information

NPI Number	:	1639248032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NENA H FENNELL MED.CCC-SLP L

Provider Business Mailing Address
First Line	:	1370 BLYTH WALK
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5923
Country	:	US
Telephone Number	:	770-736-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	2386 CLOWER ST
Second Line	:	BUILD. E, SUITE 102
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-6134
Country	:	US
Telephone Number	:	770-985-9050
Fax Number	:	770-985-9223

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. NENA H FENNELL MED.CCC-SLP L” Practice Location

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