Provider Demographics
NPI:1578941399
Name:THE SPEECH PATH PLLC
Entity Type:Organization
Organization Name:THE SPEECH PATH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN HOGG
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:859-353-3666
Mailing Address - Street 1:210 N BROADWAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2212
Mailing Address - Country:US
Mailing Address - Phone:859-353-3666
Mailing Address - Fax:859-448-7077
Practice Address - Street 1:210 N BROADWAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2212
Practice Address - Country:US
Practice Address - Phone:859-353-3666
Practice Address - Fax:859-448-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty