Individual
JESSICA KYLEEN STATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
225 VISTA SPRINGS CIR, LEXINGTON, SC 29072-8119
(606) 282-8270
Mailing address
PO BOX 139, BURGIN, KY 40310-0139
(606) 282-8270
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6023
SC
Other
Enumeration date
07/15/2016
Last updated
07/15/2016
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