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General NPI Number Information
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NPI Number | 1073725230
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Entity Type | Organization
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Legal Business Name | ADVANTAGE LEARNING CENTER, LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2620 WILHITE DRIVE SUITE 209
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-327-1948
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Fax | 859-223-7386
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Provider Business Mailing Address
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Address Line | 2673 ASHBROOKE DRIVE
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City | LEXINGTON
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State | KY
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Zip | 40513
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Country | US
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Telephone | 859-223-7386
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Fax | 859-223-7386
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. SHERRY JAYNES MCCLELLAN
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Credential | M.S.,CCC-SLP
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Telephone | 859-223-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | KY1591
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License Number State | KY
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