Provider Demographics
NPI:1134579386
Name:TRISHA T. BERNARD, SLP, CCC-SLP, PLLC
Entity type:Organization
Organization Name:TRISHA T. BERNARD, SLP, CCC-SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:859-420-3613
Mailing Address - Street 1:120 KENTUCKY AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1899
Mailing Address - Country:US
Mailing Address - Phone:859-420-3613
Mailing Address - Fax:855-476-5682
Practice Address - Street 1:120 KENTUCKY AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1899
Practice Address - Country:US
Practice Address - Phone:859-420-3613
Practice Address - Fax:855-476-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142670252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency