Active NPI
Marjorie Ann Bagwell Kukor, PHD
- Clinical Psychologist
- Springfield, OH
National Provider Identifier
1104009166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6340
- Practice address
- 1130 Vester Ave
Suite C
Springfield, OH 45503-7302 - Phone
- (937) 390-3800
- Fax
- (937) 390-3804
- NPI assigned
- Dec 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6340 | OH | |
| Psychologist | 103T00000X | PPY01684 | MO | |
| Clinical Psychologist | 103TC0700X | 6340 | OH | Primary |
Addresses
Primary practice location
1130 Vester Ave
Suite C
Springfield, OH 45503-7302
Mailing address
1130 Vester Ave
Suite C
Springfield, OH 45503-7302
Phone (937) 390-3800
Other names 1
- Marjorie Bagwell Kukor
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PPY01684 | MO | MD | Psychologist |
| 6340 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Positive Perspectives, Inc. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252368000000",
"number": "1104009166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1130 VESTER AVE",
"address_2": "SUITE C",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455037302",
"telephone_number": "937-390-3800",
"fax_number": "937-390-3804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 VESTER AVE",
"address_2": "SUITE C",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455037302",
"telephone_number": "937-390-3800",
"fax_number": "937-390-3804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGWELL KUKOR",
"first_name": "MARJORIE",
"middle_name": "ANN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-13",
"last_updated": "2009-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "6340",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "PPY01684",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "6340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARJORIE",
"last_name": "KUKOR",
"middle_name": "BAGWELL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Springfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.