MEDICARE: JENNIFER BURST

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	106S00000X	Behavior Technician	RBT-20-138003	CO
2	106E00000X	Assistant Behavior Analyst	0-23-14458	CO
3	103K00000X	Behavior Analyst	1-26-88802	CO

General Provider Information

NPI Number	:	1841897873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BURST

Provider Business Mailing Address
First Line	:	1555 VAPOR TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-2722
Country	:	US
Telephone Number	:	719-661-0118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 VAPOR TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-2722
Country	:	US
Telephone Number	:	719-661-0118
Fax Number	:

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

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	04/20/2026

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