Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2017041287 | MO |
NPI | 1003320813 |
---|---|
Provider Name | Jodie Lynn Rosendal |
First Address | Kansas City, MO 64118-4770 |
Second Address | Kansas City, MO 64118-4770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2017 |
Last Update Date | 01/12/2017 |