Provider Demographics
NPI:1245421759
Name:HOUK, JENNIFER LESHEA (MS, CFY/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LESHEA
Last Name:HOUK
Suffix:
Gender:F
Credentials:MS, CFY/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8136
Mailing Address - Country:US
Mailing Address - Phone:270-465-9692
Mailing Address - Fax:
Practice Address - Street 1:1980 OLD GREENSBURG RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2536
Practice Address - Country:US
Practice Address - Phone:270-465-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-07-010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1457424160Medicaid