| NPI | 1538138839 |
|---|---|
| Former Name | JESSICA L MCKENNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1260) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 2985) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2016-04-11 |