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General NPI Number Information
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NPI Number | 1003948621
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Entity Type | Individual
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Provider Name | JERRY DUNN PH.D
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63121-4400
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Country | US
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Telephone | 314-516-7342
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Fax | 314-516-6624
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Provider Business Mailing Address
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Address Line | 473 GOVERNOR DR
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City | BALLWIN
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State | MO
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Zip | 63021-6374
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Country | US
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Telephone | 636-227-5334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2003023849
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License Number State | MO
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