Provider Demographics
NPI:1710029939
Name:BURT, JENNIFRE
Entity Type:Individual
Prefix:MS
First Name:JENNIFRE
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 HIGH DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3642
Mailing Address - Country:US
Mailing Address - Phone:816-835-6241
Mailing Address - Fax:
Practice Address - Street 1:688 SE BAYBERRY LN
Practice Address - Street 2:SUITE 102
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4354
Practice Address - Country:US
Practice Address - Phone:816-525-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist