Healthcare Provider Details

I. General information

NPI: 1093702573
Provider Name (Legal Business Name): CONNIE JOHNMEYER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 7 BOX 469
APO AE
09104
DE

IV. Provider business mailing address

PSC 7 BOX 469
APO AE
09104
DE

V. Phone/Fax

Practice location:
  • Phone: 02451993378
  • Fax:
Mailing address:
  • Phone: 02451993378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberR0522
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: