Provider Demographics
NPI:1912386228
Name:SOUTHEAST KENTUCKY SPEECH PATHOLOGY, LLC
Entity Type:Organization
Organization Name:SOUTHEAST KENTUCKY SPEECH PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:606-545-2301
Mailing Address - Street 1:106 JANICE LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7418
Mailing Address - Country:US
Mailing Address - Phone:606-545-2301
Mailing Address - Fax:
Practice Address - Street 1:106 JANICE LN
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-7418
Practice Address - Country:US
Practice Address - Phone:606-545-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2360252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency