Provider Demographics
NPI:1780404889
Name:SLEMMONS, THELISE (BA)
Entity type:Individual
Prefix:
First Name:THELISE
Middle Name:
Last Name:SLEMMONS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3678
Mailing Address - Country:US
Mailing Address - Phone:502-724-4322
Mailing Address - Fax:
Practice Address - Street 1:315 TOWNEPARK CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2338
Practice Address - Country:US
Practice Address - Phone:859-436-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker