MEDICARE: CARRIE KEBELBECK M.A.CCC

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	SP 9740	CA

General Provider Information

NPI Number	:	1508254467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE KEBELBECK M.A.CCC

Provider Business Mailing Address
First Line	:	6824 E ESPANITA ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6824 E ESPANITA ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4817
Country	:	US
Telephone Number	:	310-293-3692
Fax Number	:

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

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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