MEDICARE: KRISTI WETZIG KEENE MS, 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	19598	TX

General Provider Information

NPI Number	:	1568667814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI WETZIG KEENE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3508 FAR WEST BLVD
Second Line	:	SUITE 240
City	:	AUSTIN
State	:	TX
Zip	:	78731-3080
Country	:	US
Telephone Number	:	512-832-9411
Fax Number	:	512-832-9401

Provider Business Practice Location Address
First Line	:	3508 FAR WEST BLVD
Second Line	:	SUITE 240
City	:	AUSTIN
State	:	TX
Zip	:	78731-3080
Country	:	US
Telephone Number	:	512-832-9411
Fax Number	:	512-832-9401

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/12/2011

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Directions to “ KRISTI WETZIG KEENE MS, CCC-SLP” Practice Location

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