Healthcare Provider Details

I. General information

NPI: 1245114768
Provider Name (Legal Business Name): LORI COLEEN SVOBODA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI COLEEN THOMPSON

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 GOLDSMITH LN
LOUISVILLE KY
40218-2066
US

IV. Provider business mailing address

7407 LANFAIR DR
LOUISVILLE KY
40241-2716
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-3207
  • Fax:
Mailing address:
  • Phone: 502-609-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: