Provider Demographics
NPI:1669247854
Name:INGRAM, JANNA ELAINE (PLPC)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:ELAINE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:ELAINE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 PETTIJOHN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-1129
Mailing Address - Country:US
Mailing Address - Phone:660-216-4794
Mailing Address - Fax:417-944-1440
Practice Address - Street 1:1108 E PATTERSON ST STE 5
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4002
Practice Address - Country:US
Practice Address - Phone:660-216-4794
Practice Address - Fax:417-944-1440
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional