Provider Demographics
NPI:1790802635
Name:SPEECH PATHOLOGY ASSOCIATES 20
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY ASSOCIATES 20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:859-227-0543
Mailing Address - Street 1:107 SHUN PIKE
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1452
Mailing Address - Country:US
Mailing Address - Phone:859-227-0543
Mailing Address - Fax:859-881-0970
Practice Address - Street 1:107 SHUN PIKE
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1452
Practice Address - Country:US
Practice Address - Phone:859-227-0543
Practice Address - Fax:859-881-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 2392251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services