Healthcare Provider Details

I. General information

NPI: 1972697415
Provider Name (Legal Business Name): ANNA ROSS HERTEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN ST
MOUNT VERNON MO
65712-1004
US

IV. Provider business mailing address

600 N MAIN ST
MOUNT VERNON MO
65712-1004
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-0198
  • Fax:
Mailing address:
  • Phone: 417-466-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2003023851
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: