Individual
AMANDA AVERETTE-BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5521 WILKE FARM AVE, LOUISVILLE, KY 40216-1269
(502) 751-1113
Mailing address
5521 WILKE FARM AVE, LOUISVILLE, KY 40216-1269
(502) 751-1113
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE
—
KY
Enumeration date
05/23/2018
Last updated
06/16/2018
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