Individual
BRENDA DOREEN KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
01/01/2011
Contact information
Practice address
301 ELMHURST AVE, VINE GROVE, KY 40175-1211
(270) 317-0669
Mailing address
301 ELMHURST AVE, VINE GROVE, KY 40175-1211
(270) 317-0669
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
252Y00000X
KY
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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