Provider Demographics
NPI:1306060330
Name:CARROLL, JACQUELINE DENISE HOWELL (MS CCC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DENISE HOWELL
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 LONGBRIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6135
Mailing Address - Country:US
Mailing Address - Phone:859-272-7472
Mailing Address - Fax:
Practice Address - Street 1:4621 LONGBRIDGE LANE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6135
Practice Address - Country:US
Practice Address - Phone:859-272-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist