JERRY DAVENPORT

GIRARD, KS
NPI1043579725
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: KS  461)
Enumeration Date2012-05-15
Last Update Date2012-05-15
Business Address
-- JERRY DAVENPORT LAC
810 CEDAR ST
GIRARD, KS 66743-2056
Phone number: 620-724-8806
Mailing Address
-- JERRY DAVENPORT LAC
911 E CENTENNIAL DR
PITTSBURG, KS 66762-6601
Phone number: 620-231-5130
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