Provider Demographics
NPI:1649592999
Name:RASPBERRY, JANETTE MCKENZIE
Entity type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:MCKENZIE
Last Name:RASPBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2062
Mailing Address - Country:US
Mailing Address - Phone:573-717-1124
Mailing Address - Fax:
Practice Address - Street 1:510 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2062
Practice Address - Country:US
Practice Address - Phone:573-717-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000155018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100204151608123Medicaid