MEDICARE: KISSTIN SCOTT MS, CCC/SLP, IBCLC

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-2850	KY

General Provider Information

NPI Number	:	1568010742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISSTIN SCOTT MS, CCC/SLP, IBCLC

Provider Business Mailing Address
First Line	:	2037 COPPER CREEK RD
Second Line	:
City	:	CRAB ORCHARD
State	:	KY
Zip	:	40419-8860
Country	:	US
Telephone Number	:	859-248-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E REYNOLDS RD STE 3
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1251
Country	:	US
Telephone Number	:	859-248-6766
Fax Number	:

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

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	03/13/2024

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Directions to “ KISSTIN SCOTT MS, CCC/SLP, IBCLC” Practice Location

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