Individual
WANDA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1721 W ELFINDALE ST, SPRINGFIELD, MO 65807-1295
(417) 874-1942
(417) 771-3723
Mailing address
1721 W ELFINDALE ST, SPRINGFIELD, MO 65807-1295
(417) 874-1942
(417) 771-3723
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2017002892
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285906107
—
MO
Enumeration date
02/21/2017
Last updated
02/21/2017
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