Provider Demographics
NPI:1033965850
Name:ALECIA SHEPHERD LANGUAGE THERAPY L
Entity Type:Organization
Organization Name:ALECIA SHEPHERD LANGUAGE THERAPY L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:ALECIA
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MAED CCC-SLP
Authorized Official - Phone:606-224-3400
Mailing Address - Street 1:5550 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-7321
Mailing Address - Country:US
Mailing Address - Phone:606-224-3400
Mailing Address - Fax:606-331-5055
Practice Address - Street 1:212 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7238
Practice Address - Country:US
Practice Address - Phone:606-224-3400
Practice Address - Fax:606-331-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100712120Medicaid