=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720666480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA JOHNSON AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2021
-----------------------------------------------------
Last Update Date | 08/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8640 N GREEN HILLS RD STE 43
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64154-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-800-8020
-----------------------------------------------------
Fax | 816-800-8029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6650 W 110TH ST STE 330
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66211-1798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-521-9090
-----------------------------------------------------
Fax | 913-521-9955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 5603
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 2024028466
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------