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NPI Code Detail

MEDICARE: KELLY ANNE SCHENK MS CCC-SLP

MEDICARE: KELLY ANNE SCHENK MS 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
1235Z00000XSpeech-Language Pathologist9936MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922616101
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANNE SCHENK MS CCC-SLP
Provider Business Mailing Address
First Line : 11800 XEON BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2099
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11800 XEON BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2061
Country : US
Telephone Number : 763-489-3637
Fax Number : 763-312-2134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2020
Last Update Date : 07/14/2020

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Directions to “ KELLY ANNE SCHENK MS CCC-SLP” Practice Location

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