Healthcare Provider Details

I. General information

NPI: 1225242779
Provider Name (Legal Business Name): INDEPENDENT SPEECH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 OLD CLEAR SPRINGS RD
RUSSELL SPRINGS KY
42642
US

IV. Provider business mailing address

1831 OLD CLEAR SPRINGS RD
RUSSELL SPRINGS KY
42642
US

V. Phone/Fax

Practice location:
  • Phone: 270-566-0172
  • Fax: 270-343-2978
Mailing address:
  • Phone: 270-566-0172
  • Fax: 270-343-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN DEAN WEST
Title or Position: PRESIDENT REHAB DIRECTORY
Credential: MS CCC SLP PRESIDENT
Phone: 270-566-0172