Provider Demographics
NPI:1225672397
Name:JANSEN, ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:JANSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12835 BLUEJACKET ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3458
Mailing Address - Country:US
Mailing Address - Phone:913-548-9794
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTHFIELD DR STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6184
Practice Address - Country:US
Practice Address - Phone:931-553-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist