Provider Demographics
NPI:1689034894
Name:KENTUCKY INNOVATIVE THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KENTUCKY INNOVATIVE THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:PATTERSON
Authorized Official - Last Name:WRENN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:859-512-4145
Mailing Address - Street 1:10120 BRANDSTEADE CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8667
Mailing Address - Country:US
Mailing Address - Phone:859-512-4145
Mailing Address - Fax:
Practice Address - Street 1:10120 BRANDSTEADE CT
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8667
Practice Address - Country:US
Practice Address - Phone:859-512-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPLPA00220284252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency