Individual
MS. JEANNIE GLORIA DAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 STROBACH ST, ROLLA, MO 65401-4243
(573) 364-4667
Mailing address
1101 STROBACH ST, ROLLA, MO 65401-4243
(573) 364-4667
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/28/2007
Last updated
07/09/2007
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