MEDICARE: MRS. KRISTEN RAE ACKERMAN M.A., CF-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	COND.2016061-SP	OH

General Provider Information

NPI Number	:	1548637424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN RAE ACKERMAN M.A., CF-SLP

Provider Business Mailing Address
First Line	:	105 CHEROKEE DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2606
Country	:	US
Telephone Number	:	614-980-3904
Fax Number	:

Provider Business Practice Location Address
First Line	:	9200 US HIGHWAY 42 S
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-9238
Country	:	US
Telephone Number	:	614-980-3904
Fax Number	:

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

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	08/27/2015

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