Provider Demographics
NPI:1881820140
Name:THE SPEECH NETWORK, INC.
Entity Type:Organization
Organization Name:THE SPEECH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SPEECH-LANGUAGE PATHOLOGIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:859-402-1553
Mailing Address - Street 1:110 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2917
Mailing Address - Country:US
Mailing Address - Phone:859-402-1553
Mailing Address - Fax:859-514-6575
Practice Address - Street 1:110 DENNIS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2917
Practice Address - Country:US
Practice Address - Phone:859-402-1553
Practice Address - Fax:859-514-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000648031OtherANTHEM PIN
KY7100146650Medicaid
KY000000648031OtherANTHEM PIN
KYP400025537Medicare PIN