Individual
DR. MARYELLEN KOCH JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC, MSED, BCBA, LBA
Contact information
Practice address
606 S HALLIBURTON ST, KIRKSVILLE, MO 63501-3712
(660) 341-1105
Mailing address
430 WAYNE 375, WILLIAMSVILLE, MO 63967-8938
(660) 341-1105
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2018037916
MO
111NN1001X
Nutrition Chiropractor
2000148952
MO
Other
Enumeration date
04/12/2007
Last updated
10/21/2024
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