Provider Demographics
NPI:1437682408
Name:KENTUCKY DOCTORS OF AUDIOLOGY
Entity Type:Organization
Organization Name:KENTUCKY DOCTORS OF AUDIOLOGY
Other - Org Name:SOUTHEAST KENTUCKY AUDIOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:606-528-9993
Mailing Address - Street 1:1707 CUMBERLAND FALLS HWY
Mailing Address - Street 2:SUITE U7
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2743
Mailing Address - Country:US
Mailing Address - Phone:606-528-9993
Mailing Address - Fax:
Practice Address - Street 1:1707 CUMBERLAND FALLS HWY
Practice Address - Street 2:SUITE U7
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2743
Practice Address - Country:US
Practice Address - Phone:606-528-9993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100078231H00000X
KY101932237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty