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Contact Information

JEANNETTE G PROVANCE
505 BURKHART
MALDEN, MO63863
 Phone: 573-276-5791
 Fax: 573-276-4993
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Speech-Language Pathologist

235Z00000X 15 Speech Language Pathologist
Indicates primary specialty

NPI Profile & details for JEANNETTE G PROVANCE · (Female)

NPI # 1619095544
Status Active
Credentials
Entity Individual
Enumeration date 03/27/2007
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 0334890
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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