Provider Demographics
NPI:1497872725
Name:TALLEY, ANITA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:M
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10100 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6103
Mailing Address - Country:US
Mailing Address - Phone:270-365-6996
Mailing Address - Fax:270-365-6133
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:CALDWELL COUNTY HOSPITAL
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2301
Practice Address - Country:US
Practice Address - Phone:270-365-0300
Practice Address - Fax:270-365-0480
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist