State of Missouri

NPI #1871128645 in Jefferson City, Missouri

Provider Information

NPI Number: 1871128645
Entity Type: Organization
Organization Name: State of Missouri
Subpart: Yes (part of a larger organization)
Parent Organization: STATE OF MISSOURI
Primary Specialty: Case Manager/Care Coordinator
Enumeration Date: Mar 11, 2020
Last Updated: Sep 3, 2020

Practice Location

Address: 1706 E ELM ST
City: Jefferson City
State: Missouri
ZIP Code: 65101-4130
Phone: (573) 751-3398

Authorized Official

Name: MOLLY JANE BOECKMANN
Title: DIRECTOR OF ADMINISTRATIVE SERVICES
Phone: (573) 751-4055

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X	Primary

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