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
State | License ID | Taxonomies |
---|---|---|
KY | KY 2392 | 251C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |