MEDICARE: KATHRYN WARREN M.A.,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	22004619A	IN

General Provider Information

NPI Number	:	1407173362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN WARREN M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	1622 SUGAR PINE DR
Second Line	:
City	:	JASPER
State	:	IN
Zip	:	47546-2202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 SUGAR PINE DR
Second Line	:
City	:	JASPER
State	:	IN
Zip	:	47546-2202
Country	:	US
Telephone Number	:	812-481-1703
Fax Number	:

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

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	04/30/2010

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