Organization Active NPI

Square One LLC

  • Developmental - Behavioral Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1063202794
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
SQUARE ONE LLC
Practice address
6440 Dutchmans Pkwy FL 2
Louisville, KY 40205-3352
Phone
(502) 896-2606
Fax
(502) 896-0487
NPI assigned
May 7, 2025
Last updated
May 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cassidy Niehaus
Title
Office Manager
Phone
(502) 896-2606

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU
Developmental - Behavioral Pediatrics Physician 2080P0006X NU Primary

Addresses

Primary practice location

6440 Dutchmans Pkwy FL 2
Louisville, KY 40205-3352

Mailing address

6440 Dutchmans Pkwy FL 2
Louisville, KY 40205-3352
Phone (502) 896-2606

National Provider Directory

National Provider Directory

Locations

6440 Dutchmans Pkwy
Fl 2
Louisville, KY 40205
Phone (502) 896-2606

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1063202794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6440 DUTCHMANS PKWY FL 2",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053352",
            "telephone_number": "502-896-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 DUTCHMANS PKWY FL 2",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053352",
            "telephone_number": "502-896-2606",
            "fax_number": "502-896-0487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE ONE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "NIEHAUS",
        "authorized_official_first_name": "CASSIDY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "502-896-2606"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.