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General NPI Number Information
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NPI Number | 1861201600
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Entity Type | Organization
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Legal Business Name | DEFYING DEMENTIA LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 239 CHIPPEWA DR
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City | BOWLING GREEN
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State | KY
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Zip | 42103-1376
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Country | US
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Telephone | 270-799-0779
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Fax |
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Provider Business Mailing Address
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Address Line | 239 CHIPPEWA DR
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City | BOWLING GREEN
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State | KY
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Zip | 42103-1376
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Country | US
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Telephone | 270-799-0779
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Fax |
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Authorized Official
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Title or Position | AUHTORIZED OFFICIAL, OWNER, PROVIDE
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Name | JENNIFER ABNEY JACOBS
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Credential | SLP
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Telephone | 270-799-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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