Provider Demographics
NPI:1336344662
Name:SIMPSON, GARY A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14511 HEARTHSIDE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-3953
Mailing Address - Country:US
Mailing Address - Phone:502-807-8711
Mailing Address - Fax:
Practice Address - Street 1:14511 HEARTHSIDE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-3953
Practice Address - Country:US
Practice Address - Phone:502-807-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2042OtherLICENSE