Provider Demographics
NPI:1639299159
Name:KENTUCKIANA THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:KENTUCKIANA THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA TEMBELESKA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TEMBELESKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:502-599-8419
Mailing Address - Street 1:5827 WAVELAND CIR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8698
Mailing Address - Country:US
Mailing Address - Phone:502-599-8419
Mailing Address - Fax:502-339-6309
Practice Address - Street 1:5827 WAVELAND CIR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8698
Practice Address - Country:US
Practice Address - Phone:502-599-8419
Practice Address - Fax:502-339-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty