Provider Demographics
NPI:1578006490
Name:DUNN, JACIE (MSSLP-CCC)
Entity type:Individual
Prefix:MS
First Name:JACIE
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:MSSLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 BURLEW BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1799
Mailing Address - Country:US
Mailing Address - Phone:270-688-8449
Mailing Address - Fax:
Practice Address - Street 1:1003 BURLEW BLVD STE C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1799
Practice Address - Country:US
Practice Address - Phone:270-688-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist