Healthcare Provider Details

I. General information

NPI: 1497353155
Provider Name (Legal Business Name): CATHERINE POLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LIBERTY RD
LEXINGTON KY
40509-4319
US

IV. Provider business mailing address

2100 LIBERTY RD
LEXINGTON KY
40509-4319
US

V. Phone/Fax

Practice location:
  • Phone: 502-777-2397
  • Fax: 502-808-6024
Mailing address:
  • Phone: 502-777-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-133862
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: