Provider Demographics
NPI:1659794238
Name:JEDLICKI, KRISTI JO
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:JO
Last Name:JEDLICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:JO
Other - Last Name:JEDLICKI LEVENHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:2203 ARDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1233
Mailing Address - Country:US
Mailing Address - Phone:502-396-0216
Mailing Address - Fax:
Practice Address - Street 1:2203 ARDSLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1233
Practice Address - Country:US
Practice Address - Phone:502-396-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0147101YA0400X
KY08771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)