Provider Demographics
NPI:1962610337
Name:NIEMANN, MARY KAY (MS CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY KAY
Middle Name:
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:MS CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2613
Mailing Address - Country:US
Mailing Address - Phone:502-298-4308
Mailing Address - Fax:502-451-2740
Practice Address - Street 1:2346 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2613
Practice Address - Country:US
Practice Address - Phone:502-298-4308
Practice Address - Fax:502-451-2740
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0648235Z00000X
KY138126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist