Individual
JENNA CLARK LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
331 SIJAN AVE, WHITEMAN AFB, WHITEMAN AFB, MO 65305
(606) 874-3416
Mailing address
331 SIJEN AVE, WHITEMAN AFB, MO 65305-1269
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810006174
VA
Other
Enumeration date
11/02/2019
Last updated
03/04/2024
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