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General NPI Number Information
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NPI Number | 1851725691
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Entity Type | Individual
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Provider Name | JESSICA LAUREN TALLENT M.S. CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 216 POPLAR AVE SUITE 101
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City | SOMERSET
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State | KY
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Zip | 42503-1764
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Country | US
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Telephone | 606-677-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 156 BLUFF RD
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City | ALBANY
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State | KY
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Zip | 42602-8974
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Country | US
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Telephone | 606-306-7036
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Fax |
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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 | 13-044
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License Number State | KY
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