Provider Demographics
NPI:1194277020
Name:BOUNDS, JACKIE
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1515
Mailing Address - Country:US
Mailing Address - Phone:660-259-2440
Mailing Address - Fax:660-251-0524
Practice Address - Street 1:324 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:MO
Practice Address - Zip Code:64016-8142
Practice Address - Country:US
Practice Address - Phone:877-344-3572
Practice Address - Fax:660-251-0524
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016029134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker