Provider Demographics
NPI:1689890105
Name:HOWELL, VIRGINIA LESLIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LESLIE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-7744
Mailing Address - Country:US
Mailing Address - Phone:606-886-9406
Mailing Address - Fax:
Practice Address - Street 1:504 RIVERSIDE DR.
Practice Address - Street 2:
Practice Address - City:PRESTONBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-886-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGN111Medicaid