Provider Demographics
NPI:1124210208
Name:TODDLER TALK: SPEECH-LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:TODDLER TALK: SPEECH-LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ED, CCC-SLP
Authorized Official - Phone:606-308-5396
Mailing Address - Street 1:643 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-8580
Mailing Address - Country:US
Mailing Address - Phone:606-308-5396
Mailing Address - Fax:606-256-9427
Practice Address - Street 1:643 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8580
Practice Address - Country:US
Practice Address - Phone:606-308-5396
Practice Address - Fax:606-256-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty