MEDICARE: MS. BETSY LYNN EAGER KESSEL MS CCCSLP

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	SLP572	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376602672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETSY LYNN EAGER KESSEL MS CCCSLP

Provider Business Mailing Address
First Line	:	2698 MORGANS WALK
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-7518
Country	:	US
Telephone Number	:	409-556-5554
Fax Number	:	770-428-2112

Provider Business Practice Location Address
First Line	:	2698 MORGANS WALK
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-7518
Country	:	US
Telephone Number	:	409-556-5554
Fax Number	:	770-428-2112

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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