Provider Demographics
NPI:1184977910
Name:EKU SPEECH-LANGUAGE-HEARING CLINIC
Entity type:Organization
Organization Name:EKU SPEECH-LANGUAGE-HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:859-622-1860
Mailing Address - Street 1:521 LANCASTER AVENUE
Mailing Address - Street 2:EKU, WALLACE 278
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-622-4444
Mailing Address - Fax:859-622-2247
Practice Address - Street 1:521 LANCASTER AVENUE
Practice Address - Street 2:EKU, WALLACE 278
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-622-4444
Practice Address - Fax:859-622-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty