Provider Demographics
NPI:1245404425
Name:DRISKILL, SUSAN W
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:DRISKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1658
Practice Address - Country:US
Practice Address - Phone:270-326-4800
Practice Address - Fax:270-326-4820
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0881231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000778279OtherBCBS TROVER CLINIC
KYP01094486OtherRR MEDICARE
KY000000778279OtherBCBS TROVER CLINIC
KYP01094486OtherRR MEDICARE