Provider Demographics
NPI:1992004956
Name:KBK SPEECH AND SWALLOWING SERVICES, LLC
Entity Type:Organization
Organization Name:KBK SPEECH AND SWALLOWING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KOPEC
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:806-786-8849
Mailing Address - Street 1:5002 COUNTY ROAD 1435
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-5744
Mailing Address - Country:US
Mailing Address - Phone:806-786-8849
Mailing Address - Fax:
Practice Address - Street 1:5002 COUNTY ROAD 1435
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-5744
Practice Address - Country:US
Practice Address - Phone:806-786-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19785235Z00000X, 261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB158632OtherMEDICARE PTAN