Provider Demographics
NPI:1851500938
Name:EAST KENTUCKY SPEECH HEARING AND THERAPY SERVICES
Entity Type:Organization
Organization Name:EAST KENTUCKY SPEECH HEARING AND THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGAUGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:606-573-6052
Mailing Address - Street 1:PO BOX 1744
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-5744
Mailing Address - Country:US
Mailing Address - Phone:606-573-6052
Mailing Address - Fax:606-573-4030
Practice Address - Street 1:1148 COLDIRON HTS
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:KY
Practice Address - Zip Code:40806-8419
Practice Address - Country:US
Practice Address - Phone:606-573-6052
Practice Address - Fax:606-573-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty