Provider Demographics
NPI:1124109079
Name:POLLOCK, ANN MARGARET (PSYD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARGARET
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1943
Mailing Address - Country:US
Mailing Address - Phone:573-634-5400
Mailing Address - Fax:573-635-9657
Practice Address - Street 1:1303 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1943
Practice Address - Country:US
Practice Address - Phone:573-634-5400
Practice Address - Fax:573-635-9657
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical