Healthcare Provider Details

I. General information

NPI: 1588547392
Provider Name (Legal Business Name): EMILY KATHLEEN ZUKAUSKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 COMMONWEALTH CT STE B
LOUISVILLE KY
40299-2355
US

IV. Provider business mailing address

1901 COMMONWEALTH CT STE B
LOUISVILLE KY
40299-2355
US

V. Phone/Fax

Practice location:
  • Phone: 502-458-9978
  • Fax:
Mailing address:
  • Phone: 502-458-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number300305
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: