Provider Demographics
NPI:1639376668
Name:SHAW, NATALIE WILSON (AUD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:WILSON
Last Name:SHAW
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3815 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1902
Mailing Address - Country:US
Mailing Address - Phone:270-804-0658
Mailing Address - Fax:
Practice Address - Street 1:580 WESTPORT RD # B
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2949
Practice Address - Country:US
Practice Address - Phone:270-765-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0484231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist