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General NPI Number Information
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NPI Number | 1659815629
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Entity Type | Organization
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Legal Business Name | JENNIFER M POLLARD LLC
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Dates
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Enumeration Date | 12/11/2016
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Last Update Date | 12/11/2016
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Provider Practice Location Address
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Address Line | 2744 CLEVELAND BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40206-1102
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Country | US
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Telephone | 502-592-4167
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Fax |
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Provider Business Mailing Address
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Address Line | 2744 CLEVELAND BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40206-1102
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Country | US
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Telephone | 502-592-4167
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER POLLARD
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Credential | MED, BCBA, LBA
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Telephone | 502-592-4167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 171380
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License Number State | KY
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