MEDICARE: TINOTENDA CHIEDZA MUPAMBO

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	528570	MN

General Provider Information

NPI Number	:	1851085658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINOTENDA CHIEDZA MUPAMBO

Provider Business Mailing Address
First Line	:	150 SOUTH RD
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-7046
Country	:	US
Telephone Number	:	507-389-6298
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SOUTH RD
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-7046
Country	:	US
Telephone Number	:	507-389-6298
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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Directions to “ TINOTENDA CHIEDZA MUPAMBO ” Practice Location

Language	Start Address	Practice Location

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