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General NPI Number Information
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NPI Number | 1376990911
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Entity Type | Organization
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Legal Business Name | PRYOR PEDIATRIC SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 174 EMILYS WAY
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City | CADIZ
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State | KY
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Zip | 42211-9210
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Country | US
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Telephone | 270-350-0159
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Fax | 270-522-4024
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Provider Business Mailing Address
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Address Line | 174 EMILYS WAY
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City | CADIZ
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State | KY
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Zip | 42211-9210
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Country | US
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Telephone | 270-350-0159
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Fax | 270-522-4024
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | KIMBERLY PRYOR
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Credential | M.S., CCC-SLP
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Telephone | 270-350-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 3729
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License Number State | KY
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