Provider Demographics
NPI:1720237449
Name:CLEVENGER, CHRISTY JO (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:JO
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 ROLLING HILLS EST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-2290
Mailing Address - Country:US
Mailing Address - Phone:606-437-5019
Mailing Address - Fax:
Practice Address - Street 1:280 ROLLING HILLS EST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2290
Practice Address - Country:US
Practice Address - Phone:606-437-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist