Healthcare Provider Details

I. General information

NPI: 1104102359
Provider Name (Legal Business Name): KAREN MILLS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAURA SUE HUMPHRESS DR
CAMPBELLSVILLE KY
42718-8899
US

IV. Provider business mailing address

105 LAURA SUE HUMPHRESS DR
CAMPBELLSVILLE KY
42718-8899
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-7768
  • Fax: 270-465-0068
Mailing address:
  • Phone: 270-465-7768
  • Fax: 270-465-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3796
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: