Provider Demographics
NPI:1528132974
Name:GRAYSON SPEECH THERAPY
Entity type:Organization
Organization Name:GRAYSON SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCSLP
Authorized Official - Phone:606-475-9564
Mailing Address - Street 1:361 WINDBURN LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-8372
Mailing Address - Country:US
Mailing Address - Phone:606-475-9564
Mailing Address - Fax:606-475-9564
Practice Address - Street 1:361 WINDBURN LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-8372
Practice Address - Country:US
Practice Address - Phone:606-475-9564
Practice Address - Fax:606-475-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA1700224Z00000X
KY003783225100000X
KYA01644225200000X
KY1610225X00000X
KY2573225X00000X
KY2093225X00000X
KY5384225X00000X
KY1422235Z00000X
KY1653235Z00000X
KY1587235Z00000X
KY1841235Z00000X
KY1405235Z00000X
KY2366235Z00000X
KY2695235Z00000X
KY002054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty