Provider Demographics
NPI:1417493701
Name:SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:SPEECH THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEAL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GOWER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:618-638-3939
Mailing Address - Street 1:2855 N FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8605
Mailing Address - Country:US
Mailing Address - Phone:270-415-5169
Mailing Address - Fax:
Practice Address - Street 1:2855 N FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8605
Practice Address - Country:US
Practice Address - Phone:270-415-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170761261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech