Provider Demographics
NPI:1811025075
Name:GRAYSON COUNTY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:GRAYSON COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SP ED
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAVRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-259-4011
Mailing Address - Street 1:P.O. BOX 4009
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755-4009
Mailing Address - Country:US
Mailing Address - Phone:270-259-4011
Mailing Address - Fax:270-259-4756
Practice Address - Street 1:909 BRANDENBURG RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2001
Practice Address - Country:US
Practice Address - Phone:270-259-4011
Practice Address - Fax:270-259-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY402065876101YS0200X
KY406703489101YS0200X
KYKY0738103T00000X
KYKY-0464103T00000X
KYKY-A0771224Z00000X
KY004308225100000X
KYA01496225200000X
KY1054009225X00000X
KYKY-2369235Z00000X
KYKY-2669235Z00000X
KYKY-2857235Z00000X
KYKY-1214235Z00000X
KYKY-3120235Z00000X
KYKY-06-014235Z00000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21043013Medicaid