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General NPI Number Information
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NPI Number | 1093014011
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Entity Type | Individual
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Provider Name | KELLY RENEE PEIFER SHENK CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 101 N COLLEGE AVE
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City | ANNVILLE
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State | PA
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Zip | 17003-1400
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Country | US
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Telephone | 717-867-6705
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Fax |
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Provider Business Mailing Address
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Address Line | 973 GAULT RD
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City | NEW HOLLAND
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State | PA
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Zip | 17557-9011
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Country | US
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Telephone | 717-468-1570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL007495
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License Number State | PA
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