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General NPI Number Information
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NPI Number | 1265932123
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Entity Type | Organization
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Legal Business Name | INTERACTIVE THERAPY SERVICES
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Dates
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Enumeration Date | 02/17/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 2801 ADAMS ST
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City | ASHLAND
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State | KY
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Zip | 41102-6007
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Country | US
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Telephone | 606-465-9754
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 ADAMS ST
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City | ASHLAND
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State | KY
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Zip | 41102-6007
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Country | US
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Telephone | 606-465-9754
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JENNIFER C VICE
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Credential | M.S. CCC-SLP
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Telephone | 606-465-9754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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