Provider Demographics
NPI:1649495557
Name:MATHIS THERAPY AND SENSORY LEARNING CENTER, PSC
Entity type:Organization
Organization Name:MATHIS THERAPY AND SENSORY LEARNING CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:270-827-4857
Mailing Address - Street 1:2003 STAPP DR.
Mailing Address - Street 2:SUITE C
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2663
Mailing Address - Country:US
Mailing Address - Phone:270-827-4857
Mailing Address - Fax:270-827-9773
Practice Address - Street 1:2003 STAPP DR.
Practice Address - Street 2:SUITE C
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2663
Practice Address - Country:US
Practice Address - Phone:270-827-4857
Practice Address - Fax:270-827-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IN22001840A235Z00000X
KYKY0401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty