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General NPI Number Information
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NPI Number | 1518465350
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Entity Type | Organization
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Legal Business Name | BLUEGRASS FIBEROPTIC ENDOSCOOIC EVALUATION OF SWALLOWING (FEES)
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 171 N EAGLE CREEK DR STE 102
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City | LEXINGTON
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State | KY
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Zip | 40509-1801
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Country | US
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Telephone | 202-378-0547
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Fax |
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Provider Business Mailing Address
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Address Line | 404 HOLLOW CREEK RD APT 24
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City | LEXINGTON
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State | KY
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Zip | 40511-1708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | FATIMA WARREN
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Credential | MS CCC-SLP
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Telephone | 202-378-0547
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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 | 140628
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License Number State | KY
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