Individual
DR. JACQUELINE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3702 W TRUMAN BLVD, SUITE 115, JEFFERSON CITY, MO 65109-4970
(573) 634-5303
(573) 761-6888
Mailing address
308 BINDER DR, JEFFERSON CITY, MO 65109-0817
(573) 638-2658
(573) 761-6888
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
33758
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33758
STATE LICENSES
MO
Enumeration date
06/21/2006
Last updated
07/08/2007
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