Healthcare Provider Details

I. General information

NPI: 1285610311
Provider Name (Legal Business Name): JENNIFER ELAINE BURTON MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE AT PEOR 530 NE GLEN OAK AVE.
PEORIA IL
61637-0001
US

IV. Provider business mailing address

505 ARROWHEAD
HEYWORTH IL
61745-9341
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-9584
  • Fax:
Mailing address:
  • Phone: 217-390-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: