MEDICARE: ANN NUNNALLY 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	100884	TX

General Provider Information

NPI Number	:	1437398625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN NUNNALLY CCC-SLP

Provider Business Mailing Address
First Line	:	2109 W SPRING CREEK PKWY
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75023-4189
Country	:	US
Telephone Number	:	972-964-7073
Fax Number	:	972-943-3441

Provider Business Practice Location Address
First Line	:	2109 W SPRING CREEK PKWY
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75023-4189
Country	:	US
Telephone Number	:	972-964-7073
Fax Number	:	972-943-3441

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

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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Directions to “ ANN NUNNALLY CCC-SLP” Practice Location

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