=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013619741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATE COMMUNICATION SPEECH THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 03/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 FAIRVIEW DR.
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-229-1219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 FAIRVIEW DR.
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-229-1219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KINSEY CHAMBERS
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 859-229-1219
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------