| Chestnut Park Professionals, Llc | |
|
1215 High St Bowling Green KY 42101-2541 | |
| (270) 782-1116 | |
| (270) 782-9108 |
| Full Name | Chestnut Park Professionals, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1215 High St, Bowling Green, Kentucky |
| Authorized Official Name and Position | Corrie J Vos (OWNER) |
| Authorized Official Contact | 2707821116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chestnut Park Professionals, Llc 1215 High St Bowling Green KY 42101-2541 Ph: (270) 782-1116 | Chestnut Park Professionals, Llc 1215 High St Bowling Green KY 42101-2541 Ph: (270) 782-1116 |
| NPI Number | 1265574396 |
|---|---|
| Provider Enumeration Date | 02/13/2007 |
| Last Update Date | 04/12/2012 |
| Medicare PECOS PAC ID | 8921025230 |
|---|---|
| Medicare Enrollment ID | O20051026000749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265574396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 0670 (Kentucky) | Primary |
| Provider Name | Edwin A Hanna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134129471 PECOS PAC ID: 2567403199 Enrollment ID: I20050513000373 |
| Provider Name | Nicole L Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619136645 PECOS PAC ID: 1153506068 Enrollment ID: I20110419000505 |
| Provider Name | Frederick G Grieve |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548398183 PECOS PAC ID: 0345499745 Enrollment ID: I20120928000281 |
| Provider Name | Heather H Dausman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497049977 PECOS PAC ID: 7911139316 Enrollment ID: I20140417002048 |
| Provider Name | Jill K Duncan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669549739 PECOS PAC ID: 8820090590 Enrollment ID: I20200522000594 |
| Provider Name | Megan E Rorex |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902274913 PECOS PAC ID: 2860885993 Enrollment ID: I20220211001798 |
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