| Dreams With Wings, Inc | |
|
2106 Bardstown Rd Louisville KY 40205-1916 | |
| (502) 459-4647 | |
| (502) 456-5705 |
| Full Name | Dreams With Wings, Inc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2106 Bardstown Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Jenifer C Frommeyer (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5024594647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dreams With Wings, Inc 1579 Bardstown Rd Louisville KY 40205-1150 Ph: (502) 459-4647 | Dreams With Wings, Inc 2106 Bardstown Rd Louisville KY 40205-1916 Ph: (502) 459-4647 |
| NPI Number | 1164638516 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 05/09/2022 |
| Certification Date | 05/09/2022 |
| Medicare PECOS PAC ID | 0446525471 |
|---|---|
| Medicare Enrollment ID | O20171002001378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164638516 | NPI | - | NPPES |
| 7100351020 | Medicaid | KY | |
| 7100350130 | Medicaid | KY | |
| 7100352090 | Medicaid | KY | |
| 33000068 | Medicaid | KY |
| Provider Name | Wendy Colley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366791402 PECOS PAC ID: 1658668223 Enrollment ID: I20160926000523 |
| Provider Name | Emily K Board |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1205369139 PECOS PAC ID: 6204109895 Enrollment ID: I20170901001518 |
| Provider Name | Terri Lynn Stoltz |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1699978213 PECOS PAC ID: 8325323918 Enrollment ID: I20171012002205 |
| Provider Name | Amy P Obryan |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366821753 PECOS PAC ID: 0143649889 Enrollment ID: I20200930001675 |
| Provider Name | Angela M Bannigan |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518404011 PECOS PAC ID: 4284012907 Enrollment ID: I20220608000482 |
| Provider Name | Stephanie Blum |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1336556216 PECOS PAC ID: 4981062767 Enrollment ID: I20230627001383 |
| Provider Name | Peyton M Goodlett |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1023638590 PECOS PAC ID: 2769841014 Enrollment ID: I20230705000190 |
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