Provider Demographics
NPI:1316247265
Name:JENNIFER PATRICK, LCSW, LIMITED
Entity type:Organization
Organization Name:JENNIFER PATRICK, LCSW, LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE-PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-642-2102
Mailing Address - Street 1:2625 FAIRWAY DR
Mailing Address - Street 2:STE. A
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-4023
Mailing Address - Country:US
Mailing Address - Phone:573-642-2102
Mailing Address - Fax:
Practice Address - Street 1:2625 FAIRWAY DR
Practice Address - Street 2:STE. A
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-4023
Practice Address - Country:US
Practice Address - Phone:573-642-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1831182427OtherNPI