Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY01532 | MO |
N | 103T00000X | Psychologist | PY01532 | MO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY01532 | MO |
N | 103TF0000X | Family Psychologist | PY01532 | MO |
N | 103TP2701X | Group Psychotherapist | PY01532 | MO |
NPI | 1003933946 |
---|---|
Provider Name | Dr. Sally Pollock |
First Address | Kansas City, MO 64114-2034 |
Second Address | Kansas City, MO 64114-2034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2007 |
Last Update Date | 08/07/2007 |