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Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
1070
KY
235Z00000X
Speech-Language Pathologist
Primary
15064
OR
235Z00000X
Speech-Language Pathologist
SL011501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1070
KENTUCKY LICENSE NUMBER
KY
01
—
15064
OREGON LICENSE
OR
01
—
SL011501
PA LICENSE
PA
Enumeration date
—
Last updated
—
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