Individual
KIM ROGER JONASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2038 FRANKFORT AVE, LOUISVILLE, KY 40206-2029
(502) 893-7789
Mailing address
87 VALLEY RD, LOUISVILLE, KY 40204-1516
(502) 458-1564
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
365
KY
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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