MEDICARE: CHARLYN KAY REECE MS SLP-CCC

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	SLP-3009	ID

General Provider Information

NPI Number	:	1033696323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLYN KAY REECE MS SLP-CCC

Provider Business Mailing Address
First Line	:	89 ORD BLVD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83651-2065
Country	:	US
Telephone Number	:	208-473-6551
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 3RD AVE S
Second Line	:
City	:	PAYETTE
State	:	ID
Zip	:	83661-2832
Country	:	US
Telephone Number	:	208-642-4455
Fax Number	:

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

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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Directions to “ CHARLYN KAY REECE MS SLP-CCC” Practice Location

Language	Start Address	Practice Location

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