Organization
MOMOLOGY MATERNAL WELLNESS CLUB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE SANDERS (CREDENTIALING ADMINISTRATOR)
(502) 630-2036
Entity
Organization
Contact information
Practice address
4614 DOHN RD, LOUISVILLE, KY 40216-2902
(502) 354-8424
(502) 632-1432
Mailing address
4614 DOHN RD, LOUISVILLE, KY 40216-2902
(502) 354-8424
(502) 632-1432
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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