Healthcare Provider Details

I. General information

NPI: 1336077437
Provider Name (Legal Business Name): MISS EMMA BETH BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MAIN ST
BENTON KY
42025-1653
US

IV. Provider business mailing address

824 WHITNEY DR
PADUCAH KY
42001-6529
US

V. Phone/Fax

Practice location:
  • Phone: 270-533-3089
  • Fax: 270-573-1559
Mailing address:
  • Phone: 270-533-3089
  • Fax: 270-573-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: