Provider Demographics
NPI:1851725691
Name:TALLENT, JESSICA LAUREN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:TALLENT
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:STATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-8974
Mailing Address - Country:US
Mailing Address - Phone:606-306-7036
Mailing Address - Fax:
Practice Address - Street 1:216 POPLAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1764
Practice Address - Country:US
Practice Address - Phone:606-677-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13-044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist