Healthcare Provider Details

I. General information

NPI: 1255508701
Provider Name (Legal Business Name): BLUEGRASS THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WILLOW STONE WAY
LOUISVILLE KY
40223-2645
US

IV. Provider business mailing address

308 WILLOW STONE WAY
LOUISVILLE KY
40223-2645
US

V. Phone/Fax

Practice location:
  • Phone: 502-797-4168
  • Fax: 502-618-1757
Mailing address:
  • Phone: 502-797-4168
  • Fax: 502-618-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA JANE GRANGER
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA CCC-SLP
Phone: 502-797-4168