MEDICARE: DR. JULIE ANN O'DONNELL LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2018012574	MO
2	103T00000X	Psychologist	2575	KS

General Provider Information

NPI Number	:	1114394954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANN O'DONNELL LP

Provider Business Mailing Address
First Line	:	811 S BUSINESS HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:	660-251-6440
Fax Number	:	660-251-6441

Provider Business Practice Location Address
First Line	:	811 S BUSINESS HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:	660-251-6440
Fax Number	:	660-251-6441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	10/16/2023

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