Provider Demographics
NPI:1386772051
Name:LAKE CUMBERLAND CHILD DEVELOPMENT, INC
Entity type:Organization
Organization Name:LAKE CUMBERLAND CHILD DEVELOPMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:WITHAM
Authorized Official - Last Name:SPECK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC, SLP
Authorized Official - Phone:606-677-1166
Mailing Address - Street 1:1056 S HIGHWAY 27 STE 9
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2893
Mailing Address - Country:US
Mailing Address - Phone:606-677-1166
Mailing Address - Fax:606-677-0693
Practice Address - Street 1:1056 S HIGHWAY 27 STE 9
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2893
Practice Address - Country:US
Practice Address - Phone:606-677-1166
Practice Address - Fax:606-451-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 222Q00000X, 235Z00000X, 252Y00000X
KY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty