Healthcare Provider Details

I. General information

NPI: 1134200124
Provider Name (Legal Business Name): SIMETRIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 DUTCHMANS LN # A
LOUISVILLE KY
40207-4712
US

IV. Provider business mailing address

4040 DUTCHMANS LN # A
LOUISVILLE KY
40207-4712
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-0404
  • Fax: 502-895-0752
Mailing address:
  • Phone: 502-895-0404
  • Fax: 502-895-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0388
License Number StateKY

VIII. Authorized Official

Name: DANA LYNN DEYOUNG
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 502-245-0767