MEDICARE: KIMBERLY SHARITZ M.S. 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	0000001871	TN

General Provider Information

NPI Number	:	1932491313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SHARITZ M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	302 WESLEY ST STE 8
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 WESLEY ST STE 8
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1741
Country	:	US
Telephone Number	:	423-282-1700
Fax Number	:

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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Directions to “ KIMBERLY SHARITZ M.S. CCC-SLP” Practice Location

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