Basic Information
| Provider Information | |||||||||
| NPI: | 1699735894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURROWS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | KAREN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5427 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511025427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122746729 | ||||||||
| FaxNumber: | 7122746744 | ||||||||
| Practice Location | |||||||||
| Address1: | 3549 SOUTHERN HILLS DR | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122746729 | ||||||||
| FaxNumber: | 7122746744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 01841 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0220467 | 05 | IA | MEDICAID |