Provider Demographics
NPI:1235336439
Name:RICHESON, JENNIFER MARIE LIKENS (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE LIKENS
Last Name:RICHESON
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:LIKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4454
Mailing Address - Country:US
Mailing Address - Phone:270-485-6120
Mailing Address - Fax:
Practice Address - Street 1:1901 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4454
Practice Address - Country:US
Practice Address - Phone:270-485-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-06-24
Deactivation Date:2018-04-24
Deactivation Code:
Reactivation Date:2018-05-16
Provider Licenses
StateLicense IDTaxonomies
KY3276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45118379Medicaid
KY11903135OtherMEDICAID ICF
KY33000035OtherMEDICAID SCL
184517Medicare ID - Type Unspecified