# PEDIATRIC EVALUATION CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851072672
- **Authorized official:** KELLEY HAMILTON (CREDENTIALING)
- **Authorized official phone:** (303) 506-1905

## Contact information

- **Practice address:** 1401 BRANDENBURG RD, LEITCHFIELD, KY 42754-1805
- **Practice address phone:** (270) 899-0424
- **Mailing address:** 1401 BRANDENBURG RD, LEITCHFIELD, KY 42754-1805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | Yes |
| 103T00000X | Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 07/25/2023
- **Last updated:** 07/25/2023