MEDICARE: KIMBERLY BROWNELL MA, 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	18103	TX

General Provider Information

NPI Number	:	1720566268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BROWNELL MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1429 TOM SAWYER RD
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4370
Country	:	US
Telephone Number	:	512-300-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 TOM SAWYER RD
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4370
Country	:	US
Telephone Number	:	512-300-1399
Fax Number	:

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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