Healthcare Provider Details

I. General information

NPI: 1538931779
Provider Name (Legal Business Name): ANN ELIZABETH MCGLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 2ND ST
HENDERSON KY
42420-3231
US

IV. Provider business mailing address

113 LAKEVIEW DR
BLOOMFIELD KY
40008-8401
US

V. Phone/Fax

Practice location:
  • Phone: 859-699-8195
  • Fax:
Mailing address:
  • Phone: 859-699-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: