Individual
DR. JORDAN S FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3011 BALTIMORE AVE, KANSAS CITY, MO 64108-3403
(159) 874-6836
Mailing address
17751 WEXFORD ST, ROSEVILLE, MI 48066-4629
(913) 449-6522
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301019267
MI
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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