Healthcare Provider Details

I. General information

NPI: 1396982211
Provider Name (Legal Business Name): SMITH, STOCKHAMMER AND ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 GLENRIDGE PARK PL STE 5
LOUISVILLE KY
40222-3452
US

IV. Provider business mailing address

6511 GLENRIDGE PARK PL STE 5
LOUISVILLE KY
40222-3452
US

V. Phone/Fax

Practice location:
  • Phone: 502-614-7600
  • Fax:
Mailing address:
  • Phone: 502-614-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FELICIA D. SMITH
Title or Position: MEMBER
Credential: PHD
Phone: 502-614-7600