Individual
MS. JEANNETTE G PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
505 BURKHART, MALDEN, MO 63863
(573) 276-5791
(573) 276-4993
Mailing address
505 BURKHART, MALDEN, MO 63863
(573) 276-5791
(573) 276-4993
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0334890
MO
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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