Provider Demographics
NPI:1750180493
Name:BURNETT, JENNIPHER (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIPHER
Middle Name:
Last Name:BURNETT
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 1/2 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9533
Mailing Address - Country:US
Mailing Address - Phone:505-553-4987
Mailing Address - Fax:
Practice Address - Street 1:213 1/2 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9533
Practice Address - Country:US
Practice Address - Phone:505-553-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist