Provider Demographics
NPI:1164781464
Name:DANON, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DANON
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 1:8212 MACKEY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3550
Mailing Address - Country:US
Mailing Address - Phone:402-203-5072
Mailing Address - Fax:
Practice Address - Street 1:4800 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1937
Practice Address - Country:US
Practice Address - Phone:402-203-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2019-08-29
Deactivation Date:2019-08-14
Deactivation Code:
Reactivation Date:2019-08-21
Provider Licenses
StateLicense IDTaxonomies
MO2019031573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist