MEDICARE: BECKY KAY KRISHER 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	109730	TX

General Provider Information

NPI Number	:	1548491871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY KAY KRISHER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	384 TREELINE PARK APT 1111
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	330-361-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	11110 FARGO RD NW
Second Line	:
City	:	MINERAL CITY
State	:	OH
Zip	:	44656-8934
Country	:	US
Telephone Number	:	330-859-2937
Fax Number	:

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

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	09/04/2018

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