MEDICARE: MRS. REBECCA CROW CLEM MS-CCC-SLP,CERTAVT

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	8633	TX

General Provider Information

NPI Number	:	1730213646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA CROW CLEM MS-CCC-SLP,CERTAVT

Provider Business Mailing Address
First Line	:	3809 SHELBY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2736
Country	:	US
Telephone Number	:	817-924-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3809 SHELBY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2736
Country	:	US
Telephone Number	:	817-924-6363
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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