Individual
DR. JILLON S. VANDER WAL
Active
Individual
DR. JILLON S. VANDER WAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
2004021723
MO
103TB0200X
Cognitive & Behavioral Psychologist
LP03007
KS
103TC0700X
Clinical Psychologist
2004021723
MO
103TC0700X
Clinical Psychologist
Primary
LP03007
KS
103TH0100X
Health Service Psychologist
2004021723
MO
103TH0100X
Health Service Psychologist
LP03007
KS
Other
Enumeration date
05/16/2007
Last updated
05/31/2022
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