Provider Demographics
NPI:1184902041
Name:WALTON, JENNA KATHERINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:KATHERINE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNA
Other - Middle Name:KATHERINE
Other - Last Name:GULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:779 PECKS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-8511
Mailing Address - Country:US
Mailing Address - Phone:606-748-0593
Mailing Address - Fax:
Practice Address - Street 1:862 CASSIDY PIKE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:KY
Practice Address - Zip Code:41039-8498
Practice Address - Country:US
Practice Address - Phone:606-748-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist