Provider Demographics
NPI:1528040227
Name:DANN, JENNIFER ELAINE (MSCCCA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:DANN
Suffix:
Gender:F
Credentials:MSCCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7720
Mailing Address - Country:US
Mailing Address - Phone:816-415-3233
Mailing Address - Fax:
Practice Address - Street 1:676 SE BAYBERRY LN STE 105
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4389
Practice Address - Country:US
Practice Address - Phone:816-415-3233
Practice Address - Fax:816-415-3234
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118465237600000X
KS1947237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22494034OtherBCBS
MOP11735Medicare UPIN
KSK35A497AMedicare PIN
MOK35A497Medicare PIN