MEDICARE: JENNIFER SALMONS LPC

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	101YP2500X	Professional Counselor	2004017130	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004017130	OTHER	MO	LPC LICENSE
2	11653034	OTHER	MO	CAQH #

General Provider Information

NPI Number	:	1568414639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SALMONS LPC

Provider Business Mailing Address
First Line	:	1508 NW VIVION RD STE 311
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4557
Country	:	US
Telephone Number	:	816-529-7784
Fax Number	:	816-222-0404

Provider Business Practice Location Address
First Line	:	1508 NW VIVION RD STE 311
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4557
Country	:	US
Telephone Number	:	816-529-7784
Fax Number	:	816-222-0404

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/26/2020

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