Healthcare Provider Details

I. General information

NPI: 1730936675
Provider Name (Legal Business Name): COMMONWEALTH THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 JOINER AVENUE
ELKTON KY
42220-8825
US

IV. Provider business mailing address

109 JOINER AVENUE
ELKTON KY
42220-8825
US

V. Phone/Fax

Practice location:
  • Phone: 270-878-0109
  • Fax:
Mailing address:
  • Phone: 270-878-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIA FOX WIDDOWSON
Title or Position: OWNER/THERAPIST
Credential: CCC-SLP
Phone: 270-878-0109