=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104908946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RHONDAS SPEECH THERAPY FOR BABIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1271 BEAR TRACK RD
-----------------------------------------------------
City | BEATTYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-464-2058
-----------------------------------------------------
Fax | 606-464-8347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1271 BEAR TRACK RD
-----------------------------------------------------
City | BEATTYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-464-2058
-----------------------------------------------------
Fax | 606-464-8347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST OWNER
-----------------------------------------------------
Name | RHONDA GAIL SHORTRIDGE DURBIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-464-2058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------