Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2003023849 | MO |
Y | 103TC0700X | Clinical Psychologist | 2003023849 | MO |
NPI | 1003948621 |
---|---|
Provider Name | Jerry Dunn |
First Address | Ballwin, MO 63021-6374 |
Second Address | Saint Louis, MO 63121-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |