Individual
MARJORIE ANN BAGWELL KUKOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1130 VESTER AVE, SUITE C, SPRINGFIELD, OH 45503-7302
(937) 390-3800
(937) 390-3804
Mailing address
1130 VESTER AVE, SUITE C, SPRINGFIELD, OH 45503-7302
(937) 390-3800
(937) 390-3804
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6340
OH
103T00000X
Psychologist
PPY01684
MO
103TC0700X
Clinical Psychologist
Primary
6340
OH
Other
Enumeration date
12/13/2007
Last updated
09/08/2009
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