Provider Demographics
NPI:1225603855
Name:KEMP, LOUISE ASHLEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ASHLEY
Last Name:KEMP
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7910
Mailing Address - Country:US
Mailing Address - Phone:708-513-8319
Mailing Address - Fax:
Practice Address - Street 1:4320 BELL SHOALS RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7171
Practice Address - Country:US
Practice Address - Phone:813-643-1389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist