Healthcare Provider Details

I. General information

NPI: 1780026922
Provider Name (Legal Business Name): MEGAN SMITH-LIBKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN HOLLEY SMITH

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 04/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1007
  • Fax: 502-437-0624
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-437-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13-053
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: