| Organization Name: | 21C SPEECH- LANGUAGE TELEPRACTICE |
| NPI Number: | 1477908390 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER LEIGH GROSS (SPEECH LANGUAGE PATHOLOGIST/ OWNER) |
| Mailing Address: | 543 General Cruft Dr Richmond |
| State: | KY US |
| Postal Code: | 404757520 |
| Phone Number: | 8595823659 |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2016 |
| NPI Last Update Date: | 04/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2151 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |