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General NPI Number Information
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NPI Number | 1538654082
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Entity Type | Individual
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Provider Name | ALICIA L FEDEWA PHD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 2039 REGENCY RD STE 6
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City | LEXINGTON
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State | KY
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Zip | 40503-2334
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Country | US
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Telephone | 502-991-8399
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Fax |
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Provider Business Mailing Address
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Address Line | 661 MOUNT VERNON DR
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City | LEXINGTON
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State | KY
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Zip | 40502-2217
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Country | US
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Telephone | 517-285-5928
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 129932
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License Number State | KY
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