MEDICARE: KARISSA GWEN NEWBERRY 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	2600	KY

General Provider Information

NPI Number	:	1235391699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA GWEN NEWBERRY SLP

Provider Business Mailing Address
First Line	:	6877 HAPPY VALLEY RD
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-9407
Country	:	US
Telephone Number	:	270-773-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	6877 HAPPY VALLEY RD
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-9407
Country	:	US
Telephone Number	:	270-773-2929
Fax Number	:

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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Directions to “ KARISSA GWEN NEWBERRY SLP” Practice Location

Language	Start Address	Practice Location

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