Individual
RENA NIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
304 N 4TH AVENUE, OZARK, MO 65721-0166
(417) 582-5952
(417) 582-5960
Mailing address
304 N 4TH AVENUE, OZARK, MO 65721-0166
(417) 582-5952
(417) 582-5960
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2002014968
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
466206901
—
MO
Enumeration date
05/04/2007
Last updated
07/09/2007
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