Healthcare Provider Details

I. General information

NPI: 1407143126
Provider Name (Legal Business Name): SPEECH UNLIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 04/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10908 OLD HARRODS WOODS CIR
LOUISVILLE KY
40223-2458
US

IV. Provider business mailing address

10908 OLD HARRODS WOODS CIR
LOUISVILLE KY
40223-2458
US

V. Phone/Fax

Practice location:
  • Phone: 505-860-7512
  • Fax:
Mailing address:
  • Phone: 505-860-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004153A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4271
License Number StateKY

VIII. Authorized Official

Name: KRISTA R JOHNSON
Title or Position: SOLE MEMBER
Credential: M.S. CCC-SLP
Phone: 505-860-7512