Provider Demographics
NPI:1093450231
Name:DUNN, TREVOR WAYNE
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:WAYNE
Last Name:DUNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LIFE CARE WAY
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2059
Mailing Address - Country:US
Mailing Address - Phone:502-348-4220
Mailing Address - Fax:
Practice Address - Street 1:120 LIFE CARE WAY
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2059
Practice Address - Country:US
Practice Address - Phone:502-348-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist