Provider Demographics
NPI:1508058744
Name:BURTON, JENNIFER LYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYN
Last Name:BURTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2541
Mailing Address - Country:US
Mailing Address - Phone:414-425-2258
Mailing Address - Fax:
Practice Address - Street 1:11035 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2541
Practice Address - Country:US
Practice Address - Phone:414-425-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist