Healthcare Provider Details

I. General information

NPI: 1548363328
Provider Name (Legal Business Name): SUE ANNE CASE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GARRETT AVE
BROOKSVILLE KY
41004-8200
US

IV. Provider business mailing address

242 GARRETT AVE
BROOKSVILLE KY
41004-8200
US

V. Phone/Fax

Practice location:
  • Phone: 606-735-3654
  • Fax: 606-735-2527
Mailing address:
  • Phone: 606-735-3654
  • Fax: 606-735-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0578
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: