Healthcare Provider Details

I. General information

NPI: 1295955961
Provider Name (Legal Business Name): JILL LYNN HUMPHREY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 MACON KESSINGER RD
MUNFORDVILLE KY
42765
US

IV. Provider business mailing address

3316 MACON KESSINGER RD
MUNFORDVILLE KY
42765-9582
US

V. Phone/Fax

Practice location:
  • Phone: 270-524-1099
  • Fax: 844-688-4227
Mailing address:
  • Phone: 270-524-1099
  • Fax: 844-688-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3011
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number142549
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: