1134631955 NPI number — MRS. COURTNEY M LEDGERWOOD LPCC

Table of content: MRS. COURTNEY M LEDGERWOOD LPCC (NPI 1134631955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134631955 NPI number — MRS. COURTNEY M LEDGERWOOD LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDGERWOOD
Provider First Name:
COURTNEY
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELTON
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134631955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 BROADWAY ST STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42001-0713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-442-7121
Provider Business Mailing Address Fax Number:
270-443-9692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001-0713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-7121
Provider Business Practice Location Address Fax Number:
270-442-7121
Provider Enumeration Date:
11/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  270445 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100759010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com