MEDICARE: KATHLEEN FARRELL M.S. 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	1440	AZ

General Provider Information

NPI Number	:	1184848178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN FARRELL M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1243 E CAVALRY RD
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-8680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1243 E CAVALRY RD
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-8680
Country	:	US
Telephone Number	:	623-694-2830
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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Directions to “ KATHLEEN FARRELL M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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