MEDICARE: JESSICA ROSE DWYER M.A.,CCC-A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	2003027555	MO

General Provider Information

NPI Number	:	1215184775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ROSE DWYER M.A.,CCC-A.

Provider Business Mailing Address
First Line	:	5101 COLLEGE BLVD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1614
Country	:	US
Telephone Number	:	816-478-4200
Fax Number	:	816-875-2598

Provider Business Practice Location Address
First Line	:	112 CONGRESS ST
Second Line	:
City	:	BELTON
State	:	MO
Zip	:	64012-2400
Country	:	US
Telephone Number	:	816-331-4327
Fax Number	:	816-875-2598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	07/19/2024

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