| Cpr Youth | |
|
1706 E Elm St Jefferson City MO 65101-4130 | |
| (573) 751-3398 | |
| Not Available |
| Full Name | Cpr Youth |
|---|---|
| Speciality | Psychologist - Rehabilitation |
| Location | 1706 E Elm St, Jefferson City, Missouri |
| Authorized Official Name and Position | Molly Jane Boeckmann (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 5737514055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cpr Youth Po Box 687 1706 E Elm St Jefferson City MO 65102-0687 Ph: (573) 751-3398 | Cpr Youth 1706 E Elm St Jefferson City MO 65101-4130 Ph: (573) 751-3398 |
| NPI Number | 1578199238 |
|---|---|
| Provider Enumeration Date | 03/13/2020 |
| Last Update Date | 10/27/2020 |
| Certification Date | 10/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578199238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TR0400X | Psychologist - Rehabilitation | (* (Not Available)) | Primary |
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