1730288630 NPI number — MRS. CHERYLLE LYNNE TROUT MSSW CSW

Table of content: MRS. CHERYLLE LYNNE TROUT MSSW CSW (NPI 1730288630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730288630 NPI number — MRS. CHERYLLE LYNNE TROUT MSSW CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROUT
Provider First Name:
CHERYLLE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSSW CSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLUMBER
Provider Other First Name:
CHERYLLE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730288630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1765 KINGS CHURCH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLORSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-538-0782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 ZORN AVENUE
Provider Second Line Business Practice Location Address:
VAMC
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-287-4000
Provider Business Practice Location Address Fax Number:
502-287-6197
Provider Enumeration Date:
09/21/2006

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: 104100000X , with the licence number:  KY4853 , 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)





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