Provider Demographics
NPI:1083285027
Name:WATHENS SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:WATHENS SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:STOUT
Authorized Official - Last Name:WATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:270-313-3819
Mailing Address - Street 1:665 OLD LEITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9446
Mailing Address - Country:US
Mailing Address - Phone:270-313-3819
Mailing Address - Fax:
Practice Address - Street 1:665 OLD LEITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378-9446
Practice Address - Country:US
Practice Address - Phone:270-313-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty