Provider Demographics
NPI:1295831600
Name:KEMNER, ANGELA JEAN (MSE, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:KEMNER
Suffix:
Gender:F
Credentials:MSE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E WILMAR DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6902
Mailing Address - Country:US
Mailing Address - Phone:217-228-0174
Mailing Address - Fax:
Practice Address - Street 1:8965 HIGHWAY 36
Practice Address - Street 2:BOX 2
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6739
Practice Address - Country:US
Practice Address - Phone:573-406-0818
Practice Address - Fax:573-406-0818
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008034851101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295831600Medicaid