MEDICARE: CARLI NIEDER

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

General Provider Information

NPI Number	:	1689432478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLI NIEDER

Provider Business Mailing Address
First Line	:	6245 NW COUNTY ROAD 7001
Second Line	:
City	:	AMORET
State	:	MO
Zip	:	64722-8598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1884 NE COUNTY ROAD 5004
Second Line	:
City	:	BUTLER
State	:	MO
Zip	:	64730-8684
Country	:	US
Telephone Number	:	660-227-1257
Fax Number	:

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

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “ CARLI NIEDER ” Practice Location

Language	Start Address	Practice Location

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