Healthcare Provider Details

I. General information

NPI: 1861685737
Provider Name (Legal Business Name): SUSAN ADAMS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MIDLAND TRL STE 1&2
SHELBYVILLE KY
40065-8141
US

IV. Provider business mailing address

1900 MIDLAND TRL STE 1&2
SHELBYVILLE KY
40065-8141
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 TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1547
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3352
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: