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NPI Code Detail

MEDICARE: TRUDY L NORTH-WOLLAK LCSW

MEDICARE: TRUDY L NORTH-WOLLAK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerKY-3120KY

General Provider Information

NPI Number : 1033248067
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRUDY L NORTH-WOLLAK LCSW
Provider Business Mailing Address
First Line : 1382 S 3RD ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40208-2351
Country : US
Telephone Number : 502-637-4361
Fax Number : 502-637-4490
Provider Business Practice Location Address
First Line : 1382 S 3RD ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40208-2351
Country : US
Telephone Number : 502-637-4361
Fax Number : 502-637-4490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 08/17/2007

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