MEDICARE: MRS. ANNE MARIE KUBAT 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	OH-SP 6552	OH
2	235Z00000X	Speech-Language Pathologist	22004576A	IN

General Provider Information

NPI Number	:	1285682088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE MARIE KUBAT M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	500 OVAL DR
Second Line	:	HEAVILON HALL SLHS
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2038
Country	:	US
Telephone Number	:	765-494-3809
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 OVAL DR
Second Line	:	HEAVILON HALL SLHS
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2038
Country	:	US
Telephone Number	:	765-494-3809
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/21/2008

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Directions to “ MRS. ANNE MARIE KUBAT M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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