Healthcare Provider Details

I. General information

NPI: 1164638516
Provider Name (Legal Business Name): DREAMS WITH WINGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 BARDSTOWN RD
LOUISVILLE KY
40205-1916
US

IV. Provider business mailing address

1579 BARDSTOWN RD
LOUISVILLE KY
40205-1150
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-4647
  • Fax: 502-456-5705
Mailing address:
  • Phone: 502-459-4647
  • Fax: 502-456-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENIFER C FROMMEYER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 502-459-4647