Provider Demographics
NPI:1164849550
Name:BLUE, NEISHA DANIEL (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NEISHA
Middle Name:DANIEL
Last Name:BLUE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 JACK HINTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILPOT
Mailing Address - State:KY
Mailing Address - Zip Code:42366-9640
Mailing Address - Country:US
Mailing Address - Phone:270-316-8549
Mailing Address - Fax:
Practice Address - Street 1:8005 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-7079
Practice Address - Country:US
Practice Address - Phone:270-295-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist