Healthcare Provider Details

I. General information

NPI: 1124293501
Provider Name (Legal Business Name): THERESA B JAVIER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 FURMAN BLVD
LOUISVILLE KY
40220-1949
US

IV. Provider business mailing address

3231 FURMAN BLVD
LOUISVILLE KY
40220-1949
US

V. Phone/Fax

Practice location:
  • Phone: 502-473-0529
  • Fax: 502-458-5751
Mailing address:
  • Phone: 502-473-0529
  • Fax: 502-458-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberKY1643
License Number StateKY

VIII. Authorized Official

Name: MRS. THERESA B JAVIER
Title or Position: PRES
Credential: M.S. CCC SLP
Phone: 502-473-0529