Provider Demographics
NPI:1972956837
Name:STATON, JESSICA KYLEEN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KYLEEN
Last Name:STATON
Suffix:
Gender:F
Credentials:MA 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:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:BURGIN
Mailing Address - State:KY
Mailing Address - Zip Code:40310-0139
Mailing Address - Country:US
Mailing Address - Phone:606-282-8270
Mailing Address - Fax:
Practice Address - Street 1:225 VISTA SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8119
Practice Address - Country:US
Practice Address - Phone:606-282-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist