MEDICARE: CHERYL REID COLE PSYD

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
1	103TC0700X	Clinical Psychologist	928	KY

General Provider Information

NPI Number	:	1255484242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL REID COLE PSYD

Provider Business Mailing Address
First Line	:	10630 WEMBERLEY HILL BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-3420
Country	:	US
Telephone Number	:	502-412-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	3906 DUPONT SQ S STE A
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4647
Country	:	US
Telephone Number	:	502-896-1850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	07/08/2007

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