Provider Demographics
NPI:1467867697
Name:WIGHT SPEECH AND LANGUAGE SERVICES, LLC
Entity Type:Organization
Organization Name:WIGHT SPEECH AND LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:270-926-8534
Mailing Address - Street 1:1115 TAMARACK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6934
Mailing Address - Country:US
Mailing Address - Phone:270-926-8534
Mailing Address - Fax:270-685-2058
Practice Address - Street 1:1115 TAMARACK RD STE 400
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6934
Practice Address - Country:US
Practice Address - Phone:270-926-8234
Practice Address - Fax:270-685-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty