Provider Demographics
NPI:1841498698
Name:DOWN SYNDROME OF LOUISVILLE, INC.
Entity type:Organization
Organization Name:DOWN SYNDROME OF LOUISVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIMES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-495-5088
Mailing Address - Street 1:5001 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-2893
Mailing Address - Country:US
Mailing Address - Phone:502-495-5088
Mailing Address - Fax:502-495-5038
Practice Address - Street 1:5001 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2893
Practice Address - Country:US
Practice Address - Phone:502-495-5088
Practice Address - Fax:502-495-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X, 222Q00000X, 222Q00000X
KYKY-1424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty