| Jodi Glaus Pingel, Llc | |
|
300 Ozark Trail Dr Suite 217 Ellisville MO 63011-2166 | |
| (636) 891-9760 | |
| (636) 891-9765 |
| Full Name | Jodi Glaus Pingel, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 300 Ozark Trail Dr, Ellisville, Missouri |
| Authorized Official Name and Position | Jodi Glaus Pingel (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 6368919760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jodi Glaus Pingel, Llc 300 Ozark Trail Dr Suite 217 Ellisville MO 63011-2166 Ph: (636) 891-9760 | Jodi Glaus Pingel, Llc 300 Ozark Trail Dr Suite 217 Ellisville MO 63011-2166 Ph: (636) 891-9760 |
| NPI Number | 1790071629 |
|---|---|
| Provider Enumeration Date | 06/20/2011 |
| Last Update Date | 06/20/2011 |
| Medicare PECOS PAC ID | 6901074277 |
|---|---|
| Medicare Enrollment ID | O20110713000329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790071629 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2003030079 (Missouri) | Primary |
| Provider Name | Jodi G Pingel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689737595 PECOS PAC ID: 7810915832 Enrollment ID: I20051109000010 |
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