Provider Demographics
NPI:1437296373
Name:LINDBERG, JENNIFER (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 GREGORY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-9453
Mailing Address - Country:US
Mailing Address - Phone:502-395-1637
Mailing Address - Fax:502-415-7455
Practice Address - Street 1:852 GREGORY WOODS RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-9453
Practice Address - Country:US
Practice Address - Phone:502-395-1637
Practice Address - Fax:502-227-4241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200161371222Q00000X
KYSLPLPA00220274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist