Provider Demographics
NPI:1700447406
Name:FARMER, MYRANDA JUNE (SLP)
Entity Type:Individual
Prefix:
First Name:MYRANDA
Middle Name:JUNE
Last Name:FARMER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MYRANDA
Other - Middle Name:JUNE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4914
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1400 CUMBERLAND FALLS HWY STE C
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2739
Practice Address - Country:US
Practice Address - Phone:606-528-2149
Practice Address - Fax:606-528-2338
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist