Individual
JESSICA M ELLIS-HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, PLP
Contact information
Practice address
1350 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4376
(417) 761-5000
(417) 761-5011
Mailing address
3660 S COX AVE APT 2208, SPRINGFIELD, MO 65807-6950
(606) 171-0087
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2017033402
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490047302
—
MO
Enumeration date
10/03/2017
Last updated
03/30/2020
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