Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0115 | KY |
NPI | 1063813491 |
---|---|
Provider Name | Julie Marie Greenwell |
First Address | Louisville, KY 40206-2639 |
Second Address | Louisville, KY 40206-2639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 04/09/2014 |