Individual
ANGELA JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
505 S 11TH STREET TER, CLINTON, MO 64735-2319
(660) 924-6189
Mailing address
505 S 11TH STREET TER, CLINTON, MO 64735-2319
(660) 924-6189
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2012000882
MO
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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