Individual
JUDITH A KELLENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1230 N DUQUESNE RD, JOPLIN, MO 64801-1509
(417) 782-1443
Mailing address
3555 ALPACA RD, JOPLIN, MO 64804-8735
(417) 781-9160
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01618
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
496912734
—
MO
Enumeration date
03/24/2006
Last updated
07/15/2014
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