Provider Demographics
NPI:1740962844
Name:CHLOE BOHLEN SPEECH THERAPY LLC
Entity type:Organization
Organization Name:CHLOE BOHLEN SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:859-912-1411
Mailing Address - Street 1:2441 SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-4200
Mailing Address - Country:US
Mailing Address - Phone:859-912-1411
Mailing Address - Fax:
Practice Address - Street 1:2441 SHEFFIELD PL
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-4200
Practice Address - Country:US
Practice Address - Phone:859-912-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100972770Medicaid