MEDICARE: MS. BRETT ALICE KLUETZ MA, 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	04696	MD

General Provider Information

NPI Number	:	1144503327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRETT ALICE KLUETZ MA, CCC-SLP

Provider Business Mailing Address
First Line	:	4108 CULVER ST
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-3624
Country	:	US
Telephone Number	:	410-274-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	4108 CULVER ST
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-3624
Country	:	US
Telephone Number	:	410-274-1205
Fax Number	:

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

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	11/06/2015

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