Individual
JENNIE L BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 E 5TH ST, FULTON, MO 65251-1753
(573) 592-4100
Mailing address
600 E 5TH ST, FULTON, MO 65251-1753
(573) 592-4100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2017033389
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017033389
MEDICAL LICENSE
MO
Enumeration date
11/01/2018
Last updated
11/01/2018
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