Individual
CATHERINE M HISSINK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
300 W CHERRY ST, NEVADA, MO 64772-2202
(417) 667-4230
(417) 667-7607
Mailing address
300 W CHERRY ST, P. O. BOX 125, NEVADA, MO 64772-2202
(417) 667-4230
(417) 667-7607
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01351
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
PY01351
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20591015
BLUE CROSS OF WESTERN MO
MO
05
—
493314306
—
MO
Enumeration date
01/03/2007
Last updated
05/29/2013
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