Provider Demographics
NPI:1740603620
Name:FLOWERS, JEANNE (MSDE, MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:MSDE, MS, CCC-SLP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:LAUGHLIN
Other - Last Name:BREITMAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5065
Mailing Address - Country:US
Mailing Address - Phone:636-532-2672
Mailing Address - Fax:
Practice Address - Street 1:1809 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5065
Practice Address - Country:US
Practice Address - Phone:636-532-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012005129235Z00000X
IN22005489A235Z00000X
CA20101235Z00000X
MT2635235Z00000X
TX108115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist