Provider Demographics
NPI:1356509913
Name:MINZENBERGER, SEASON LANEE' (BACHELORS DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:SEASON
Middle Name:LANEE'
Last Name:MINZENBERGER
Suffix:
Gender:F
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4014
Mailing Address - Country:US
Mailing Address - Phone:502-644-7760
Mailing Address - Fax:
Practice Address - Street 1:4209 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4014
Practice Address - Country:US
Practice Address - Phone:502-644-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator