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General NPI Number Information
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NPI Number | 1851072672
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Entity Type | Organization
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Legal Business Name | PEDIATRIC EVALUATION CLINIC, PLLC
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 1401 BRANDENBURG RD
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1805
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Country | US
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Telephone | 270-899-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 BRANDENBURG RD
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KELLEY HAMILTON
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Credential |
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Telephone | 303-506-1905
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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 |
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License Number State |
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