Provider Demographics
NPI:1073293171
Name:CULLUM, EMILY K
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:CULLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3295
Mailing Address - Country:US
Mailing Address - Phone:205-470-9557
Mailing Address - Fax:
Practice Address - Street 1:2944 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1409
Practice Address - Country:US
Practice Address - Phone:502-995-5525
Practice Address - Fax:770-615-6091
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002932A231H00000X
390200000X
KY300876231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program