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General NPI Number Information
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NPI Number | 1568172286
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Entity Type | Individual
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Provider Name | JANA GEORGEANNE BREMENKAMP LCP
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 9100 W 74TH ST
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City | MERRIAM
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State | KS
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Zip | 66204-4004
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Country | US
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Telephone | 913-789-3218
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Fax | 913-789-3213
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Provider Business Mailing Address
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Address Line | 7311 HAUSER DR
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City | SHAWNEE
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State | KS
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Zip | 66216-4137
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Country | US
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Telephone | 913-271-4210
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 207
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2798185866
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License Number State | KS
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