Individual
TEGAN JAE FANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
T-LMLP
Contact information
Practice address
1000 LINCOLN ST, EMPORIA, KS 66801-2449
(620) 343-2211
Mailing address
1000 LINCOLN ST, EMPORIA, KS 66801-2449
(620) 343-2211
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1298
KS
Other
Enumeration date
09/17/2009
Last updated
09/17/2009
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