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General NPI Number Information
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NPI Number | 1184977910
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Entity Type | Organization
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Legal Business Name | EKU SPEECH-LANGUAGE-HEARING CLINIC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 521 LANCASTER AVENUE EKU, WALLACE 278
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City | RICHMOND
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State | KY
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Zip | 40475
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Country | US
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Telephone | 859-622-4444
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Fax | 859-622-2247
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Provider Business Mailing Address
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Address Line | 521 LANCASTER AVENUE EKU, WALLACE 278
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City | RICHMOND
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State | KY
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Zip | 40475
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Country | US
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Telephone | 859-622-4444
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Fax | 859-622-2247
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. KELLIE ELLIS
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Credential | M.A. CCC-SLP
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Telephone | 859-622-1860
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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 | 2930
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License Number State | KY
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