MEDICARE: BENJAMIN SPEELMAN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-89732	KY

General Provider Information

NPI Number	:	1063097467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN SPEELMAN BCBA

Provider Business Mailing Address
First Line	:	3006 EASTPOINT PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4185
Country	:	US
Telephone Number	:	502-795-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 OLD BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4490
Country	:	US
Telephone Number	:	502-427-6040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	06/15/2026

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