Provider Demographics
NPI:1306294178
Name:MAXEY SPEECH PATHOLOGY, LLC
Entity type:Organization
Organization Name:MAXEY SPEECH PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAHANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-313-5220
Mailing Address - Street 1:3040 CREEK BRANCH CV
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4461
Mailing Address - Country:US
Mailing Address - Phone:270-313-5220
Mailing Address - Fax:270-691-9119
Practice Address - Street 1:3040 CREEK BRANCH CV
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4461
Practice Address - Country:US
Practice Address - Phone:270-313-5220
Practice Address - Fax:270-691-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY136808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty