Provider Demographics
NPI:1619374956
Name:SPEISMAN, JENNIFER (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SPEISMAN
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E EUCLID AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1783
Mailing Address - Country:US
Mailing Address - Phone:561-235-2536
Mailing Address - Fax:
Practice Address - Street 1:836 E EUCLID AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1783
Practice Address - Country:US
Practice Address - Phone:561-235-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 1689103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical