Healthcare Provider Details

I. General information

NPI: 1073795944
Provider Name (Legal Business Name): SOUTHEAST KENTUCKY AUDIOLOGY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ALLISON BLVD
CORBIN KY
40701-7964
US

IV. Provider business mailing address

200 ALLISON BLVD
CORBIN KY
40701-7964
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-9993
  • Fax: 606-528-5553
Mailing address:
  • Phone: 606-528-9993
  • Fax: 606-528-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number00380
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ROGERS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 606-528-9993