Individual
CHERYL R LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
1300 E BRADFORD PKWY BLDG B, SPRINGFIELD, MO 65804-4264
(417) 269-5400
(417) 269-7212
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 269-5400
(417) 269-7212
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2000159808
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
495004905
—
MO
Enumeration date
06/27/2005
Last updated
10/30/2025
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