Healthcare Provider Details

I. General information

NPI: 1699684233
Provider Name (Legal Business Name): BROOKLYN CLAIRE ODONOGHUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ODONOGHUE GLENN LN
HARNED KY
40144-6077
US

IV. Provider business mailing address

181 ODONOGHUE GLENN LN
HARNED KY
40144-6077
US

V. Phone/Fax

Practice location:
  • Phone: 628-250-7500
  • Fax:
Mailing address:
  • Phone: 628-250-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-526856
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: