Individual
ELAINE ANNE3/17/1962 BODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1815 E HAMILTON ST, KIRKSVILLE, MO 63501-3903
(660) 665-5691
(660) 626-1421
Mailing address
1901 E HAMILTON ST, KIRKSVILLE, MO 63501-3904
(660) 665-7774
(660) 665-3281
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2013029464
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013029464
MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS
MO
01
—
SPEECH LANGUAGE PATH
DEPARTMENT OF ELMENTARY AND SECONDARY EDUCATION
MO
Enumeration date
01/21/2014
Last updated
01/21/2014
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