MEDICARE: KATHY FARNEN CHRISTIAN CCC-SP

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	002181-1	NY
2	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1477706521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY FARNEN CHRISTIAN CCC-SP

Provider Business Mailing Address
First Line	:	293 11TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3910
Country	:	US
Telephone Number	:	718-768-2723
Fax Number	:	718-680-7977

Provider Business Practice Location Address
First Line	:	420 95TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7404
Country	:	US
Telephone Number	:	718-680-9751
Fax Number	:	718-680-7977

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

Provider Enumeration Date	:	11/01/2008
Last Update Date	:	05/20/2013

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