Healthcare Provider Details

I. General information

NPI: 1124009972
Provider Name (Legal Business Name): MARION LAWRENCE CALDWELL AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 S DANVILLE BYP
DANVILLE KY
40422-2529
US

IV. Provider business mailing address

3940 S DANVILLE BYP
DANVILLE KY
40422-2529
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-3865
  • Fax: 859-236-1690
Mailing address:
  • Phone: 859-236-3865
  • Fax: 859-236-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberKY0106
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: