Healthcare Provider Details

I. General information

NPI: 1144452616
Provider Name (Legal Business Name): JOYCE ANNE WALLEN M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE ST STE B317
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ STE 200
LEXINGTON KY
40517-4022
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3390
  • Fax: 859-257-5989
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0070
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0336
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: