Healthcare Provider Details

I. General information

NPI: 1013546258
Provider Name (Legal Business Name): JANICE KAY BURKEMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

PO BOX 209
TROY MO
63379-0209
US

V. Phone/Fax

Practice location:
  • Phone: 636-477-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: