MEDICARE: SARAH KELLY M.S., 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	107926	TX

General Provider Information

NPI Number	:	1841702230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KELLY M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	10317 TREVINO LN
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-4594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4403
Country	:	US
Telephone Number	:	325-864-6264
Fax Number	:

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

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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