Provider Demographics
NPI:1346393493
Name:KALAWSKI, JUAN PABLO (PH D)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:KALAWSKI
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2638
Mailing Address - Country:US
Mailing Address - Phone:502-235-7782
Mailing Address - Fax:
Practice Address - Street 1:12701 TOWNEPARK WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2384
Practice Address - Country:US
Practice Address - Phone:502-235-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2007-4103T00000X
KY1512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000506062OtherANTHEM
KY0690944Medicare PIN
KY0359098Medicare PIN
KY0763539Medicare PIN
KY0974712Medicare PIN
KY0359296Medicare PIN
KY0762339Medicare PIN
KY0358998Medicare PIN
KY0358696Medicare PIN
KY0358897Medicare PIN
KY0762241Medicare PIN
KY0358796Medicare PIN