| NPI | 1922163781 |
|---|---|
| Doing Business As | JANE DOMKE, PHD |
| Entity Type | Organization |
| Authorized Contact | MICHAEL CRAIGHEAD COO 573-556-7776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-11-29 |