MEDICARE: STEPHANIE KEHRES

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	04734	MD

General Provider Information

NPI Number	:	1871062331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KEHRES

Provider Business Mailing Address
First Line	:	9748 TREYBURN CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2373
Country	:	US
Telephone Number	:	410-707-6466
Fax Number	:

Provider Business Practice Location Address
First Line	:	12041 ROUTE 108
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1232
Country	:	US
Telephone Number	:	410-313-7050
Fax Number	:

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

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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Directions to “ STEPHANIE KEHRES ” Practice Location

Language	Start Address	Practice Location

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