Healthcare Provider Details

I. General information

NPI: 1538617287
Provider Name (Legal Business Name): KELLY TWEHUES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 N FORT THOMAS AVE STE 302
FORT THOMAS KY
41075-1595
US

IV. Provider business mailing address

18 N FORT THOMAS AVE STE 302
FORT THOMAS KY
41075-1595
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-0139
  • Fax: 859-441-0125
Mailing address:
  • Phone: 859-441-0139
  • Fax: 859-441-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number138430
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number138430
License Number StateKY

VIII. Authorized Official

Name: KELLY CRAWFORD TWEHUES
Title or Position: OWNER/SLP
Credential: MA CCC-SLP
Phone: 859-441-0139