Provider Demographics
NPI:1306975560
Name:BIRDWHISTELL, DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BIRDWHISTELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 S RUTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2461
Mailing Address - Country:US
Mailing Address - Phone:502-235-3334
Mailing Address - Fax:
Practice Address - Street 1:KADEN TOWER STE 303
Practice Address - Street 2:6100 DUTCHMAN'S LANE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3284
Practice Address - Country:US
Practice Address - Phone:502-896-1850
Practice Address - Fax:502-896-6863
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4875104100000X
KY33991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker