Healthcare Provider Details

I. General information

NPI: 1962450817
Provider Name (Legal Business Name): JAN SNIDER KENT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN SNIDER KENT P.H.D.

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E 32ND ST STE 221
JOPLIN MO
64804-4300
US

IV. Provider business mailing address

2650 E 32ND ST STE 221
JOPLIN MO
64804-4300
US

V. Phone/Fax

Practice location:
  • Phone: 417-623-1381
  • Fax: 417-623-0457
Mailing address:
  • Phone: 417-623-1381
  • Fax: 417-623-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01592
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: