| NPI | 1538750880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE LEA FORTHMAN Credentialing Manager 270-557-6396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-03-31 |