Healthcare Provider Details

I. General information

NPI: 1013177708
Provider Name (Legal Business Name): DR. RANDEE SHENKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 FORUM BLVD STE 4
COLUMBIA MO
65203-6322
US

IV. Provider business mailing address

2804 FORUM BLVD STE 4
COLUMBIA MO
65203-6322
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-5034
  • Fax: 573-446-5046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2007000381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: