Healthcare Provider Details

I. General information

NPI: 1275448052
Provider Name (Legal Business Name): ROBERT S LOUALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CHAMPION WAY STE 7
GEORGETOWN KY
40324-8861
US

IV. Provider business mailing address

PO BOX 92
HARRODSBURG KY
40330-0092
US

V. Phone/Fax

Practice location:
  • Phone: 502-603-0020
  • Fax:
Mailing address:
  • Phone: 859-612-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW00001711
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: