Provider Demographics
NPI:1083899249
Name:ANDERSON-PEERY, JENIFER LYN (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:LYN
Last Name:ANDERSON-PEERY
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 NE SUNVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2045
Mailing Address - Country:US
Mailing Address - Phone:816-224-0938
Mailing Address - Fax:
Practice Address - Street 1:2108 SW MITCHELL ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9472
Practice Address - Country:US
Practice Address - Phone:816-690-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist