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NPI Code Detail

MEDICARE: KELLY D ANNEN RPSGT

MEDICARE: KELLY D ANNEN RPSGT
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
1235500000XSpeech/Language/Hearing Specialist/Technologist24478IN

General Provider Information

NPI Number : 1740870245
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY D ANNEN RPSGT
Provider Business Mailing Address
First Line : 2101 DUBOIS DR
Second Line :
City : WARSAW
State : IN
Zip : 46580-3210
Country : US
Telephone Number : 574-372-5889
Fax Number :
Provider Business Practice Location Address
First Line : 2101 DUBOIS DR
Second Line :
City : WARSAW
State : IN
Zip : 46580-3210
Country : US
Telephone Number : 574-372-5889
Fax Number : 574-372-5889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2021
Last Update Date : 01/19/2021

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