MEDICARE: ELIZABETH M KITCHEN MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	KY-3098	KY

General Provider Information

NPI Number	:	1194875328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M KITCHEN MS CCC-SLP

Provider Business Mailing Address
First Line	:	504 CROYDON CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-5551
Country	:	US
Telephone Number	:	502-931-0678
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 BONNIE LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3207
Country	:	US
Telephone Number	:	502-671-1787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/03/2008

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