Provider Demographics
NPI:1366983694
Name:COLE, JENNIFER (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DEINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1120 S SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2512
Mailing Address - Country:US
Mailing Address - Phone:417-326-7814
Mailing Address - Fax:417-326-4059
Practice Address - Street 1:1120 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2512
Practice Address - Country:US
Practice Address - Phone:417-326-7814
Practice Address - Fax:417-326-4059
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017005257101YM0800X
MO2017037305103TB0200X
KS02938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral