Healthcare Provider Details

I. General information

NPI: 1417315532
Provider Name (Legal Business Name): SALLY KUHLENSCHMIDT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 COLLEGE HEIGHTS BLVD. #21030 DEPARTMENT OF PSYCHOLOGY, WESTERN KENTUCKY UNIVERSITY
BOWLING GREEN KY
42101-1030
US

IV. Provider business mailing address

1906 COLLEGE HEIGHTS BLVD. #21030 DEPARTMENT OF PSYCHOLOGY, WESTERN KENTUCKY UNIVERSITY
BOWLING GREEN KY
42101-1030
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-2114
  • Fax: 270-745-6934
Mailing address:
  • Phone: 270-745-2114
  • Fax: 270-745-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0622
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: