Provider Demographics
NPI:1538534292
Name:KINGORE, JANESSA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:KINGORE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-1076
Mailing Address - Country:US
Mailing Address - Phone:417-540-1587
Mailing Address - Fax:
Practice Address - Street 1:411 N MADISON ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-1238
Practice Address - Country:US
Practice Address - Phone:417-673-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015021285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist