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General NPI Number Information
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NPI Number | 1639523442
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH SPEECH & LANGUAGE PATHOLOGY SERVICES
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 3486 STAMPER DR
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City | WINCHESTER
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State | KY
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Zip | 40391-1159
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Country | US
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Telephone | 859-351-7933
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Fax | 859-745-9463
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Provider Business Mailing Address
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Address Line | 3486 STAMPER DR
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City | WINCHESTER
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State | KY
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Zip | 40391-1159
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Country | US
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Telephone | 859-351-7933
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Fax | 859-745-9463
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Authorized Official
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Title or Position | SOLE PROPRIETOR/OWNER/SLP
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Name | SANDY NELSON
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Credential | SLP
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Telephone | 859-351-7933
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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 | 0670
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License Number State | KY
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