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NPI Code Detail

MEDICARE: BRENDA SHORT

MEDICARE: BRENDA SHORT
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 Worker1038KY

General Provider Information

NPI Number : 1063834802
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA SHORT
Provider Business Mailing Address
First Line : 1015 DORSEY LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-2612
Country : US
Telephone Number : 502-271-4657
Fax Number : 502-254-7906
Provider Business Practice Location Address
First Line : 1015 DORSEY LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-2612
Country : US
Telephone Number : 502-271-4657
Fax Number : 502-254-7906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2014
Last Update Date : 01/15/2014

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Directions to “ BRENDA SHORT ” Practice Location

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