Provider Demographics
NPI:1275281669
Name:NOONAN, JACQUELINE DIANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:DIANE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:DIANE
Other - Last Name:RUVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4145 W 131ST TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-4139
Mailing Address - Country:US
Mailing Address - Phone:914-388-7567
Mailing Address - Fax:
Practice Address - Street 1:300 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2759
Practice Address - Country:US
Practice Address - Phone:816-404-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25876103TC0700X
MD06316103TC0700X
KS02989103TC0700X
MO2021004232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical