Provider Demographics
NPI:1801140405
Name:MILES, JENNIFER BROOKE (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:MILES
Suffix:
Gender:F
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 1:415 NE LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4716
Mailing Address - Country:US
Mailing Address - Phone:816-216-1027
Mailing Address - Fax:
Practice Address - Street 1:415 NE LINDBERG DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4716
Practice Address - Country:US
Practice Address - Phone:816-216-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist