Healthcare Provider Details

I. General information

NPI: 1508218827
Provider Name (Legal Business Name): MARY (KATIE) KATHERINE IRWIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CASEY ST STE A
CAMPBELLSVILLE KY
42718-6858
US

IV. Provider business mailing address

300 MEADOWBROOK DR APT 2
CAMPBELLSVILLE KY
42718-1952
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-7768
  • Fax:
Mailing address:
  • Phone: 859-421-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: