Healthcare Provider Details

I. General information

NPI: 1033309331
Provider Name (Legal Business Name): MIKI WATANABE DUKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 WESTPORT RD
LOUISVILLE KY
40242-3042
US

IV. Provider business mailing address

8300 WESTPORT RD
LOUISVILLE KY
40242-3042
US

V. Phone/Fax

Practice location:
  • Phone: 502-889-5533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105757
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: