Individual
KEANU IRENE HACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
204 E MARKET ST # A, LOUISVILLE, KY 40202-1218
(502) 588-4340
Mailing address
4717 CLIFF AVE, LOUISVILLE, KY 40215-2420
(502) 554-0380
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/15/2021
Last updated
11/15/2021
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