Provider Demographics
NPI:1861201600
Name:DEFYING DEMENTIA LLC
Entity type:Organization
Organization Name:DEFYING DEMENTIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUHTORIZED OFFICIAL, OWNER, PROVIDE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ABNEY
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:270-799-0779
Mailing Address - Street 1:239 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1376
Mailing Address - Country:US
Mailing Address - Phone:270-799-0779
Mailing Address - Fax:
Practice Address - Street 1:239 CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1376
Practice Address - Country:US
Practice Address - Phone:270-799-0779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty