Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 2009035448 | MO |
NPI | 1003107228 |
---|---|
Provider Name | Jennifer Kridelbaugh |
First Address | Waynesville, MO 65583-2634 |
Second Address | Waynesville, MO 65583-2634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 21/04/2011 |