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General NPI Number Information
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NPI Number | 1366983694
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Entity Type | Individual
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Provider Name | JENNIFER COLE PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 1120 S SPRINGFIELD AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-2512
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Country | US
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Telephone | 417-326-7814
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Fax | 417-326-4059
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Provider Business Mailing Address
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Address Line | 1120 S SPRINGFIELD AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-2512
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Country | US
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Telephone | 417-326-7814
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Fax | 417-326-4059
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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 | 02938
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2017005257
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2017037305
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License Number State | MO
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