Provider Demographics
NPI:1992837405
Name:ALLEN, JAYNE M (MSCCC)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GADWALL LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7850
Mailing Address - Country:US
Mailing Address - Phone:859-771-1593
Mailing Address - Fax:859-744-0281
Practice Address - Street 1:112 GADWALL LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7850
Practice Address - Country:US
Practice Address - Phone:859-771-1593
Practice Address - Fax:859-744-0281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1362235Z00000X
KY139846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100427200Medicaid
KY7100427200Medicaid