Provider Demographics
NPI:1760847719
Name:DODSON, THEODOSIA VITTOS (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:THEODOSIA
Middle Name:VITTOS
Last Name:DODSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WINDSOR PATH
Mailing Address - Street 2:SUITES 2 & 4
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9610
Mailing Address - Country:US
Mailing Address - Phone:502-863-3870
Mailing Address - Fax:502-863-1287
Practice Address - Street 1:103 WINDSOR PATH
Practice Address - Street 2:SUITES 2 & 4
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9610
Practice Address - Country:US
Practice Address - Phone:502-863-3870
Practice Address - Fax:502-863-1287
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPINP00218793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist