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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERESA JENNEWEIN MHA (CEO)
(417) 983-6497
Entity
Organization

Contact information

Practice address
2405 ASPEN RD, HIGHLANDVILLE, MO 65669-8051
(417) 983-6497
Mailing address
2405 ASPEN RD, HIGHLANDVILLE, MO 65669-8051
(417) 983-6497

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Enumeration date
04/21/2020
Last updated
04/21/2020
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