Individual
JENNA SUE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
221 E KING ST, ANDOVER, KS 67002-8964
(316) 733-5047
Mailing address
520 E AUGUSTA AVE, AUGUSTA, KS 67010-2100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
03267-T
KS
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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