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General NPI Number Information
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NPI Number | 1952788408
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Entity Type | Organization
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Legal Business Name | BRIDGETT POWERS MATTINGLY
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 117 WEISSER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2761
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Country | US
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Telephone | 502-930-3187
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Fax |
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Provider Business Mailing Address
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Address Line | 117 WEISSER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2761
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Country | US
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Telephone | 502-930-3187
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST
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Name | BRIDGETT MATTINGLY
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Credential | MS, CCC-SLP
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Telephone | 502-930-3187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | KY-2387
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License Number State | KY
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