Healthcare Provider Details

I. General information

NPI: 1255050027
Provider Name (Legal Business Name): RASHIDA LOUISE MEDERICA PRINT MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RASHIDA LOUISE MEDERICA LAKE MA CCC-SLP

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CAVALIER BLVD
FLORENCE KY
41042-3966
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 859-899-2022
  • Fax:
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-805-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number265918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: