Provider Demographics
NPI:1245865534
Name:SOUTHERN KENTUCKY SPEECH THERAPY
Entity type:Organization
Organization Name:SOUTHERN KENTUCKY SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:DAWNE
Authorized Official - Last Name:ESPINOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:270-202-5998
Mailing Address - Street 1:812 MANDARIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7215
Mailing Address - Country:US
Mailing Address - Phone:270-202-5998
Mailing Address - Fax:
Practice Address - Street 1:812 MANDARIN AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7215
Practice Address - Country:US
Practice Address - Phone:270-202-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty