Provider Demographics
NPI:1649312380
Name:CLINICORP SPEECH PATHOLOGY ASSOCIATES INC.
Entity type:Organization
Organization Name:CLINICORP SPEECH PATHOLOGY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DIERSING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:502-935-8522
Mailing Address - Street 1:7743 SAINT ANDREWS CHURCH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-3997
Mailing Address - Country:US
Mailing Address - Phone:502-935-8522
Mailing Address - Fax:502-413-5700
Practice Address - Street 1:7743 SAINT ANDREWS CHURCH RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-3997
Practice Address - Country:US
Practice Address - Phone:502-935-8522
Practice Address - Fax:502-413-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000380382OtherANTHEM PROVIDER ID #
KY000000380381OtherANTHEM