Provider Demographics
NPI:1295859965
Name:SPECK, DANA W (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:W
Last Name:SPECK
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 OVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-4457
Mailing Address - Country:US
Mailing Address - Phone:606-678-0349
Mailing Address - Fax:
Practice Address - Street 1:216 POPLAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1764
Practice Address - Country:US
Practice Address - Phone:606-677-1166
Practice Address - Fax:606-677-0986
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist