Healthcare Provider Details

I. General information

NPI: 1720991169
Provider Name (Legal Business Name): BKN LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 MASSILLON RD
GREEN OH
44720-1166
US

IV. Provider business mailing address

3076 E EDGERTON RD
SILVER LAKE OH
44224-3107
US

V. Phone/Fax

Practice location:
  • Phone: 330-896-9119
  • Fax:
Mailing address:
  • Phone: 440-708-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROLE MARTIN
Title or Position: OWNER
Credential:
Phone: 440-708-4815