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Organization
SQUARE ONE LLC
Active
Organization
SQUARE ONE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSIDY NIEHAUS (OFFICE MANAGER)
(502) 896-2606
Entity
Organization
Contact information
Practice address
6440 DUTCHMANS PKWY FL 2, LOUISVILLE, KY 40205-3352
(502) 896-2606
(502) 896-0487
Mailing address
6440 DUTCHMANS PKWY FL 2, LOUISVILLE, KY 40205-3352
(502) 896-2606
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Enumeration date
05/07/2025
Last updated
05/07/2025
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