Healthcare Provider Details

I. General information

NPI: 1598984858
Provider Name (Legal Business Name): KATHRYN ANN SANDUSKY AUD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SOUTHLAND DR
LEXINGTON KY
40503-1828
US

IV. Provider business mailing address

525 SOUTHLAND DR
LEXINGTON KY
40503-1828
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5090
  • Fax: 859-278-6071
Mailing address:
  • Phone: 859-277-5090
  • Fax: 859-278-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0144
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: