Healthcare Provider Details

I. General information

NPI: 1558555359
Provider Name (Legal Business Name): LAURA F. COFFEE AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 BLANKENBAKER PKWY SUITE A
LOUISVILLE KY
40243-1881
US

IV. Provider business mailing address

PO BOX 5007
FRANKFORT KY
40602-5007
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-5101
  • Fax: 502-245-7602
Mailing address:
  • Phone: 502-226-3858
  • Fax: 502-223-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0165
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: