Provider Demographics
NPI:1053457820
Name:BARNES, JENIFER JOE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:JOE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:JOE
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3511 RUTLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4021
Mailing Address - Country:US
Mailing Address - Phone:573-881-8008
Mailing Address - Fax:
Practice Address - Street 1:3511 RUTLEDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-4021
Practice Address - Country:US
Practice Address - Phone:573-881-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist