| NPI | 1063202794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSIDY NIEHAUS Office Manager 502-896-2606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2025-05-07 |
| Last Update Date | 2025-05-07 |