Healthcare Provider Details

I. General information

NPI: 1649312380
Provider Name (Legal Business Name): CLINICORP SPEECH PATHOLOGY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7743 SAINT ANDREWS CHURCH RD SUITE A
LOUISVILLE KY
40214-3997
US

IV. Provider business mailing address

7743 SAINT ANDREWS CHURCH RD SUITE A
LOUISVILLE KY
40214-3997
US

V. Phone/Fax

Practice location:
  • Phone: 502-935-8522
  • Fax: 502-413-5700
Mailing address:
  • Phone: 502-935-8522
  • Fax: 502-413-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATRINA LOUISE DIERSING
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 502-935-8522