Provider Demographics
NPI:1568172286
Name:BREMENKAMP, JANA GEORGEANNE (LCP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:GEORGEANNE
Last Name:BREMENKAMP
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:MS
Other - First Name:JANA
Other - Middle Name:GEORGEANNE
Other - Last Name:MUZYKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCP
Mailing Address - Street 1:7311 HAUSER DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-4137
Mailing Address - Country:US
Mailing Address - Phone:913-271-4210
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-789-3218
Practice Address - Fax:913-789-3213
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207102L00000X
KS2798185866103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool