Provider Demographics
NPI:1225316805
Name:HUMPHRIES, KAY E (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:E
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 BUSINESS BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7701
Mailing Address - Country:US
Mailing Address - Phone:907-694-6002
Mailing Address - Fax:907-694-6015
Practice Address - Street 1:11901 BUSINESS BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7701
Practice Address - Country:US
Practice Address - Phone:907-694-6002
Practice Address - Fax:907-694-6015
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK370261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy