Healthcare Provider Details

I. General information

NPI: 1962529743
Provider Name (Legal Business Name): TODDLER TALK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8922 ZABEL WAY
LOUISVILLE KY
40291-1553
US

IV. Provider business mailing address

8922 ZABEL WAY
LOUISVILLE KY
40291-1553
US

V. Phone/Fax

Practice location:
  • Phone: 502-299-4926
  • Fax: 502-690-4363
Mailing address:
  • Phone: 502-299-4926
  • Fax: 502-690-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2170
License Number StateKY

VIII. Authorized Official

Name: DANA MOUTACHOUIK
Title or Position: PRESIDENT
Credential: M.ED, CCC-SLP
Phone: 502-299-4926