Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2015037691 | MO |
NPI | 1003267097 |
---|---|
Provider Name | Jessica Mensah-Ruff |
First Address | Wentzville, MO 63385-3421 |
Second Address | Wentzville, MO 63385-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 30/06/2016 |