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General NPI Number Information
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NPI Number | 1265783922
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Entity Type | Individual
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Provider Name | JESSICA FLUKE MT-BC, RBT
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Gender | Female
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 10333 W 84TH TER
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City | LENEXA
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State | KS
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Zip | 66214-1639
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Country | US
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Telephone | 785-256-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 14551 S CONSTANCE ST
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City | OLATHE
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State | KS
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Zip | 66062-6597
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Country | US
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Telephone | 913-961-3847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-295075
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License Number State | KS
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