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General NPI Number Information
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NPI Number | 1790071629
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Entity Type | Organization
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Legal Business Name | JODI GLAUS PINGEL, LLC
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 300 OZARK TRAIL DR SUITE 217
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City | ELLISVILLE
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State | MO
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Zip | 63011-2166
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Country | US
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Telephone | 636-891-9760
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Fax | 636-891-9765
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Provider Business Mailing Address
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Address Line | 300 OZARK TRAIL DR SUITE 217
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City | ELLISVILLE
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State | MO
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Zip | 63011-2166
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Country | US
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Telephone | 636-891-9760
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Fax | 636-891-9765
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. JODI GLAUS PINGEL
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Credential | PSY.D.
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Telephone | 636-891-9760
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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 | 2003030079
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License Number State | MO
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