Provider Demographics
NPI:1609928241
Name:UNIVERSITY OF KY COMMUNICATIVE DISORDERS CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY OF KY COMMUNICATIVE DISORDERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:859-257-3390
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:SUITE B303
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-3390
Mailing Address - Fax:859-323-5951
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:SUITE B303
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-3390
Practice Address - Fax:859-323-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0070231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY70000708Medicaid
KY70900014Medicaid
KY70000708Medicaid