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General NPI Number Information
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NPI Number | 1659777258
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Entity Type | Organization
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Legal Business Name | RHONDA MATTINGLY LLC
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Dates
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Enumeration Date | 11/08/2014
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Last Update Date | 11/08/2014
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Provider Practice Location Address
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Address Line | 207 HILLCREST AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1535
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Country | US
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Telephone | 502-552-4598
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Fax |
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Provider Business Mailing Address
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Address Line | 207 HILLCREST AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1535
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Country | US
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Telephone | 502-552-4598
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RHONDA MATTINGLY
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Credential | EDD
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Telephone | 502-552-4598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1168
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License Number State | KY
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