Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2007000381 | MO |
NPI | 1013177708 |
---|---|
Provider Name | Dr. Randee Shenkel |
First Address | Columbia, MO 65203-6322 |
Second Address | Columbia, MO 65203-6322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |