Healthcare Provider Details

I. General information

NPI: 1699605444
Provider Name (Legal Business Name): ELIZABETH GRACE LOY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 KY-185 SUITE 2
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

5263 N HIGHWAY 55
JAMESTOWN KY
42629-6640
US

V. Phone/Fax

Practice location:
  • Phone: 270-746-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number292542
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: