Provider Demographics
NPI:1417973835
Name:BURNETT, JENNIFER LAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAYNE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2433
Mailing Address - Country:US
Mailing Address - Phone:970-324-4976
Mailing Address - Fax:
Practice Address - Street 1:3400 W 16TH ST
Practice Address - Street 2:BUILDING 7, SUITE I
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-324-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2501041C0700X
COCSW.099234441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical