Provider Demographics
NPI:1972273290
Name:BURNS, JENNA LEACH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEACH
Last Name:BURNS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:DANIELLE
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1114 JUDAH BEAR BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8415
Mailing Address - Country:US
Mailing Address - Phone:859-274-5301
Mailing Address - Fax:
Practice Address - Street 1:2150 LEXINGTON RD # AB
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7924
Practice Address - Country:US
Practice Address - Phone:859-353-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY283974235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist