Provider Demographics
NPI:1134357965
Name:BUNT, JEANETTE ANNE (MA)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ANNE
Last Name:BUNT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055B RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3621
Mailing Address - Country:US
Mailing Address - Phone:615-594-5778
Mailing Address - Fax:615-859-2668
Practice Address - Street 1:1055B RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3621
Practice Address - Country:US
Practice Address - Phone:615-594-5778
Practice Address - Fax:615-859-2668
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist