Organization
CORE14 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER ALBERTY PSY.D. (PSYCHOLOGIST)
(417) 627-9601
Entity
Organization
Contact information
Practice address
2700 N RANGE LINE RD, SUITE 101, JOPLIN, MO 64801-9100
(417) 627-9601
(417) 627-9032
Mailing address
2700 N RANGE LINE RD, SUITE 101, JOPLIN, MO 64801-9100
(417) 627-9601
(417) 627-9032
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2003019242
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881783066
—
MO
Enumeration date
09/27/2012
Last updated
10/17/2012
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