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NPI Code Detail

MEDICARE: MS. LISANNE SIMMS CRAVEN M.S.

MEDICARE: MS. LISANNE SIMMS CRAVEN M.S.
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
1235Z00000XSpeech-Language Pathologist0405KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699901637
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISANNE SIMMS CRAVEN M.S.
Provider Business Mailing Address
First Line : 2028 STRATHMOOR BLVD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-2528
Country : US
Telephone Number : 502-893-1285
Fax Number :
Provider Business Practice Location Address
First Line : 9931 FOREST GREEN BLVD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-5123
Country : US
Telephone Number : 502-588-0750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2009
Last Update Date : 08/24/2020

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Directions to “ MS. LISANNE SIMMS CRAVEN M.S.” Practice Location

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