Provider Demographics
NPI:1164699591
Name:MABE, JOAN LOEFFLER (AUD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LOEFFLER
Last Name:MABE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 POPLAR LEVEL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1395
Mailing Address - Country:US
Mailing Address - Phone:502-459-3760
Mailing Address - Fax:502-459-3717
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-459-3760
Practice Address - Fax:502-459-3717
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0115231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0124007Medicare PIN