Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1854 | KS |
NPI | 1114174067 |
---|---|
Provider Name | Dr. Brenna E Shortridge-Pearce |
First Address | Kansas City, MO 64128-2226 |
Second Address | Kansas City, MO 64128-2226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2008 |
Last Update Date | 25/07/2013 |