Provider Demographics
NPI:1801522032
Name:LAYTON, JENNIFER LIN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIN
Last Name:LAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LIN
Other - Last Name:WASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:MO
Mailing Address - Zip Code:63867-9192
Mailing Address - Country:US
Mailing Address - Phone:573-703-7974
Mailing Address - Fax:
Practice Address - Street 1:256 EAGLE DRIVE
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:MO
Practice Address - Zip Code:63867-6386
Practice Address - Country:US
Practice Address - Phone:573-703-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBRVC0V3K1MOtherEQUINE THERAPY NON MEDICAL
HERDINSTITUTEOtherEQUINE FACILITATED LEARNING - HERD INSTITUTE
BRVC0V3K1MOtherSTABLE MOMENTS