Healthcare Provider Details

I. General information

NPI: 1194988261
Provider Name (Legal Business Name): BRITTANY K HUMPHREYS MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11052 WASHINGTON TRACE RD
CALIFORNIA KY
41007-8403
US

IV. Provider business mailing address

11052 WASHINGTON TRACE RD
CALIFORNIA KY
41007-8403
US

V. Phone/Fax

Practice location:
  • Phone: 859-991-2882
  • Fax:
Mailing address:
  • Phone: 859-991-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP. 9488
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3752
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: