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General NPI Number Information
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NPI Number | 1922538511
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Entity Type | Individual
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Provider Name | LAUREL AMANDA RUTHERFORD CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 2150 LEXINGTON RD
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City | RICHMOND
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State | KY
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Zip | 40475-7924
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Country | US
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Telephone | 833-381-4759
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Fax |
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Provider Business Mailing Address
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Address Line | 2031 IDYLWILD CT
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City | RICHMOND
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State | KY
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Zip | 40475-3607
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Country | US
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Telephone | 859-979-2853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 173512
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License Number State | KY
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