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2315 Broadway St Paducah KY 42001-7113 | |
| (270) 442-8785 | |
| (270) 443-1784 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2315 Broadway St, Paducah, Kentucky |
| Authorized Official Name and Position | Julie Kraus Hideg (SOLE PROPIETOR) |
| Authorized Official Contact | 2704428785 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2315 Broadway St Paducah KY 42001-7113 Ph: (270) 442-8785 | 2315 Broadway St Paducah KY 42001-7113 Ph: (270) 442-8785 |
| NPI Number | 1053534404 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 06/22/2020 |
| Certification Date | 06/22/2020 |
| Medicare PECOS PAC ID | 4284708140 |
|---|---|
| Medicare Enrollment ID | O20080811000574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053534404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1317 (Kentucky) | Primary |
| Provider Name | Julie Kraus Hideg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669485934 PECOS PAC ID: 4981668126 Enrollment ID: I20041117000164 |
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