Healthcare Provider Details

I. General information

NPI: 1477784064
Provider Name (Legal Business Name): HOLLY JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY GRANGER

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 SPENCER CT
LA GRANGE KY
40031-6742
US

IV. Provider business mailing address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax: 502-589-8771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3739
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: