Provider Demographics
NPI:1164638516
Name:DREAMS WITH WINGS, INC
Entity Type:Organization
Organization Name:DREAMS WITH WINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FROMMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-459-4647
Mailing Address - Street 1:1579 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1150
Mailing Address - Country:US
Mailing Address - Phone:502-459-4647
Mailing Address - Fax:502-456-5705
Practice Address - Street 1:2106 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1916
Practice Address - Country:US
Practice Address - Phone:502-459-4647
Practice Address - Fax:502-456-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 225100000X, 235Z00000X, 251C00000X, 251S00000X
KY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100351020Medicaid
KY7100350130Medicaid
KY7100352090Medicaid
KY33000068Medicaid