Provider Demographics
NPI:1316031305
Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.
Other - Org Name:CHILDREN AND YOUTH PROJECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:502-852-5588
Mailing Address - Street 1:555 S FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3801
Mailing Address - Country:US
Mailing Address - Phone:502-852-5588
Mailing Address - Fax:502-852-5630
Practice Address - Street 1:555 S FLOYD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3801
Practice Address - Country:US
Practice Address - Phone:502-852-5588
Practice Address - Fax:502-852-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37OtherFIRST STEPS PROVIDER #