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General NPI Number Information
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NPI Number | 1033852678
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Entity Type | Organization
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Legal Business Name | JENNIFER BURLESON LCSW, PLLC
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1116 S WALTON BLVD STE 114
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City | BENTONVILLE
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State | AR
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Zip | 72712-6126
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Country | US
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Telephone | 917-405-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 5215 S BROOKMERE ST
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City | ROGERS
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State | AR
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Zip | 72758-5097
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Country | US
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Telephone | 917-405-5514
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER BURLESON
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Credential | MSW, LCSW
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Telephone | 917-405-5514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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