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General NPI Number Information
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NPI Number | 1316139587
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Entity Type | Individual
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Provider Name | DESIREE MILNE ANTONSON M.S LPA
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 300 FOXGLOVE DR
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City | MOUNT STERLING
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State | KY
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Zip | 40353-9769
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Country | US
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Telephone | 859-498-2135
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 BATH AVE
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City | ASHLAND
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State | KY
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Zip | 41101-2696
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Country | US
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Telephone | 606-329-8588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | KY-0988
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License Number State | KY
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