Provider Demographics
NPI:1093183287
Name:SPEELMAN, JESSICA LYNN (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SPEELMAN
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1370
Mailing Address - Country:US
Mailing Address - Phone:859-241-3085
Mailing Address - Fax:877-712-3835
Practice Address - Street 1:125 QUINN DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1370
Practice Address - Country:US
Practice Address - Phone:859-241-3085
Practice Address - Fax:877-712-3835
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262439101YP2500X
KY1627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100673010Medicaid
KYCS2028500102OtherCARESOURCE PROVIDER BILLING NUMBER