MEDICARE: MRS. GINGER LORRAINE ENZ 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	3904	KY

General Provider Information

NPI Number	:	1689058711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINGER LORRAINE ENZ MS/CCC-SLP

Provider Business Mailing Address
First Line	:	1820 OAKVIEW RD
Second Line	:	WOODLAND OAKS
City	:	ASHLAND
State	:	KY
Zip	:	41101-1309
Country	:	US
Telephone Number	:	606-325-5200
Fax Number	:	606-329-9143

Provider Business Practice Location Address
First Line	:	1820 OAKVIEW RD
Second Line	:	WOODLAND OAKS
City	:	ASHLAND
State	:	KY
Zip	:	41101-1309
Country	:	US
Telephone Number	:	606-325-5200
Fax Number	:	606-329-9143

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

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	07/18/2015

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