Healthcare Provider Details

I. General information

NPI: 1447171574
Provider Name (Legal Business Name): JANE BURNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 DEVONSHIRE AVE
SAINT LOUIS MO
63109-2841
US

IV. Provider business mailing address

5611 MURDOCH AVE
SAINT LOUIS MO
63109-2868
US

V. Phone/Fax

Practice location:
  • Phone: 501-249-3386
  • Fax:
Mailing address:
  • Phone: 501-249-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024026411
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: