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NPI Code Detail

MEDICARE: LINDA MUDD

MEDICARE: LINDA MUDD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor67KY

General Provider Information

NPI Number : 1194858472
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA MUDD
Provider Business Mailing Address
First Line : 101 W MUHAMMAD ALI BLVD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-1423
Country : US
Telephone Number : 502-589-8600
Fax Number : 502-589-8771
Provider Business Practice Location Address
First Line : 2141 SPENCER CT
Second Line :
City : LA GRANGE
State : KY
Zip : 40031-6742
Country : US
Telephone Number : 502-589-8600
Fax Number : 502-589-8771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 05/07/2013

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Directions to “ LINDA MUDD ” Practice Location

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