Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0753 | KY |
Y | 103T00000X | Psychologist | 0753 | KY |
NPI | 1013029693 |
---|---|
Provider Name | Ms. Sandra Ellen Freedman |
First Address | Louisville, KY 40202-1423 |
Second Address | Louisville, KY 40272-6808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 23/08/2011 |