Provider Demographics
NPI:1780085399
Name:GALLOWAY, LAURA ROBIN NESBITT (AUD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ROBIN NESBITT
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ROBIN
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST UNIT 170
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-583-3277
Practice Address - Fax:502-588-2351
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162390231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100324100Medicaid