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General NPI Number Information
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NPI Number | 1114465960
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Entity Type | Organization
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Legal Business Name | JO ANN AGRESS, PHD, PLLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 2740 OAK RIDGE CT STE 304
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City | FORT MYERS
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State | FL
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Zip | 33901-9371
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Country | US
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Telephone | 239-776-1855
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Fax | 239-567-5620
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Provider Business Mailing Address
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Address Line | 20410 TALON TRCE
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City | ESTERO
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State | FL
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Zip | 33928-3028
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Country | US
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Telephone | 239-948-2116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JO ANN AGRESS
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Credential | PHD
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Telephone | 239-776-1855
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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 | PY6587
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License Number State | FL
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