Provider Demographics
NPI:1023447505
Name:BURTON, JANELLE MORGAN (MS)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:MORGAN
Last Name:BURTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:MORGAN
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-9301
Mailing Address - Country:US
Mailing Address - Phone:812-838-6554
Mailing Address - Fax:
Practice Address - Street 1:1415 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-9301
Practice Address - Country:US
Practice Address - Phone:812-838-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002500A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist