Healthcare Provider Details

I. General information

NPI: 1144918137
Provider Name (Legal Business Name): ASHLEY ANNE HULSMAN GAITHER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 MEDLEY CT
VINE GROVE KY
40175-8421
US

IV. Provider business mailing address

635 S MAIN ST # B
LEITCHFIELD KY
42754-1056
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-1133
  • Fax:
Mailing address:
  • Phone: 270-287-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number284514
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: