Provider Demographics
NPI:1386995520
Name:SPEECHCO THERAPY SERVICES
Entity type:Organization
Organization Name:SPEECHCO THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-538-6333
Mailing Address - Street 1:PO BOX 91286
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-0286
Mailing Address - Country:US
Mailing Address - Phone:502-538-6333
Mailing Address - Fax:502-538-6334
Practice Address - Street 1:1123 N BARDSTOWN RD
Practice Address - Street 2:SUITE #2
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7843
Practice Address - Country:US
Practice Address - Phone:502-538-6333
Practice Address - Fax:502-538-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
P300033786OtherMEDICARE PTAN