Healthcare Provider Details

I. General information

NPI: 1265783922
Provider Name (Legal Business Name): JESSICA FLUKE MT-BC, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 W 84TH TER
LENEXA KS
66214-1639
US

IV. Provider business mailing address

14551 S CONSTANCE ST
OLATHE KS
66062-6597
US

V. Phone/Fax

Practice location:
  • Phone: 785-256-9096
  • Fax:
Mailing address:
  • Phone: 913-961-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-295075
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: