Provider Demographics
NPI:1649574146
Name:ANTON, JANE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:L
Last Name:ANTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 S CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5807
Mailing Address - Country:US
Mailing Address - Phone:314-367-2155
Mailing Address - Fax:314-835-9035
Practice Address - Street 1:471 S CLAY AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5807
Practice Address - Country:US
Practice Address - Phone:314-367-2155
Practice Address - Fax:314-835-9035
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000666103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist