Individual
ALICIA L FEDEWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2039 REGENCY RD STE 6, LEXINGTON, KY 40503-2334
(502) 991-8399
Mailing address
661 MOUNT VERNON DR, LEXINGTON, KY 40502-2217
(517) 285-5928
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
129932
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129932
LICENSE
KY
01
—
6301019090
LICENSE
MI
Enumeration date
06/27/2018
Last updated
03/31/2022
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