Provider Demographics
NPI:1669451522
Name:STEVENS, JENNIFER BOYER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BOYER
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:BOYER
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-0925
Mailing Address - Country:US
Mailing Address - Phone:573-480-7910
Mailing Address - Fax:
Practice Address - Street 1:1191 HWY KK
Practice Address - Street 2:SUITE 202
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-480-7910
Practice Address - Fax:573-302-7239
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004013642103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist