MEDICARE: KAREN PIETERS 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	100233	TX

General Provider Information

NPI Number	:	1386815579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN PIETERS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	401 HARWOOD RD STE A
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-4183
Country	:	US
Telephone Number	:	817-656-7240
Fax Number	:	817-656-7251

Provider Business Practice Location Address
First Line	:	309 HILL CREST DR
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-7122
Country	:	US
Telephone Number	:	817-656-7240
Fax Number	:	817-656-7251

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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