Provider Demographics
NPI:1073256632
Name:GAZO, CADENCE
Entity Type:Individual
Prefix:
First Name:CADENCE
Middle Name:
Last Name:GAZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 BLANCA CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1186
Mailing Address - Country:US
Mailing Address - Phone:502-235-5597
Mailing Address - Fax:
Practice Address - Street 1:1907 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1525
Practice Address - Country:US
Practice Address - Phone:502-235-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288766221700000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist