Healthcare Provider Details

I. General information

NPI: 1306295472
Provider Name (Legal Business Name): HUTCHISON SPEECH AND LANGUAGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MCFARLAND LN
BOWLING GREEN KY
42101-7837
US

IV. Provider business mailing address

1225 MCFARLAND LN
BOWLING GREEN KY
42101-7837
US

V. Phone/Fax

Practice location:
  • Phone: 270-792-6404
  • Fax: 270-746-5913
Mailing address:
  • Phone: 270-792-6404
  • Fax: 270-746-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number142371
License Number StateKY

VIII. Authorized Official

Name: MRS. LEISA HUTCHISON
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S. CCC/SLP
Phone: 270-792-6404