MEDICARE: SPEECH CARE ASSOCIATES, LLC

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	261QH0700X	Hearing and Speech Clinic/Center	1305	NE

General Provider Information

NPI Number	:	1821308024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH CARE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1320 N 113TH COURT
Second Line	:	4509
City	:	OMAHA
State	:	NE
Zip	:	68154
Country	:	US
Telephone Number	:	402-898-3950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 N 113TH COURT
Second Line	:	4509
City	:	OMAHA
State	:	NE
Zip	:	68154
Country	:	US
Telephone Number	:	402-898-3950
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MS. KJERSTIN LYNN AMAN
Credential	:	M.S., CCC-SLP
Telephone Number	:	402-898-3950

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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