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NPI Code Detail

MEDICARE: DR. JEANETTE MARITZA SIMMONS PSY.D.

MEDICARE: DR. JEANETTE MARITZA SIMMONS PSY.D.
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
1103TC0700XClinical Psychologist2002030478MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457458432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEANETTE MARITZA SIMMONS PSY.D.
Provider Business Mailing Address
First Line : 3505 FREDERICK AVE
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64506-2914
Country : US
Telephone Number : 816-387-2300
Fax Number : 816-387-2769
Provider Business Practice Location Address
First Line : 3505 FREDERICK AVE
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64506-2914
Country : US
Telephone Number : 816-387-2300
Fax Number : 816-387-2769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 04/27/2010

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