Provider Demographics
NPI:1083888556
Name:BURSON, JEAN ALISON
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ALISON
Last Name:BURSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71749-0790
Mailing Address - Country:US
Mailing Address - Phone:870-924-4575
Mailing Address - Fax:870-924-4601
Practice Address - Street 1:100 WEST HOLLY STREET
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:AR
Practice Address - Zip Code:71749-0790
Practice Address - Country:US
Practice Address - Phone:870-924-4575
Practice Address - Fax:870-924-4601
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #1964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist