MEDICARE: JENNIFER ELAINE BURTON MS, CGC

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1285610311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELAINE BURTON MS, CGC

Provider Business Mailing Address
First Line	:	505 ARROWHEAD
Second Line	:
City	:	HEYWORTH
State	:	IL
Zip	:	61745-9341
Country	:	US
Telephone Number	:	217-390-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE AT PEOR
Second Line	:	530 NE GLEN OAK AVE.
City	:	PEORIA
State	:	IL
Zip	:	61637-0001
Country	:	US
Telephone Number	:	309-624-9584
Fax Number	:

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/08/2007

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