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General NPI Number Information
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NPI Number | 1417453689
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Entity Type | Individual
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Provider Name | JENNIFER LEE MARSHALL MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 7559 THUNDER RIDGE DR
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City | FLORENCE
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State | KY
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Zip | 41042-8269
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Country | US
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Telephone | 925-918-2655
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Fax |
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Provider Business Mailing Address
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Address Line | 838 E HIGH ST # 155
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City | LEXINGTON
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State | KY
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Zip | 40502-2107
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Country | US
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Telephone | 859-545-2117
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Fax | 859-201-1251
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-10670
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 141293
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License Number State | KY
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