Individual
MRS. JENNIFER JO HACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T. ,A.T.C.
Contact information
Practice address
1420 W ASHLEY RD, BOONVILLE, MO 65233-2112
(660) 882-6115
(660) 882-6120
Mailing address
1420 W ASHLEY RD, BOONVILLE, MO 65233-2112
(660) 882-6115
(660) 882-6120
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2002024893
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122566
BLUE CROSS BLUE SHIELD
—
Enumeration date
06/14/2005
Last updated
10/17/2007
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