Individual
JENNIFER LYNN BLACKSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
402 W JEFFERSON ST, KIRKSVILLE, MO 63501-3407
(660) 627-2229
Mailing address
402 W JEFFERSON ST, KIRKSVILLE, MO 63501-3407
(660) 627-2229
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
073513
IA
103T00000X
Psychologist
Primary
2017010148
MO
Other
Enumeration date
11/05/2015
Last updated
05/10/2017
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