Provider Demographics
NPI:1366811846
Name:MUNRO, JAN (EDD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:MUNRO
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BLUE WATER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3239
Mailing Address - Country:US
Mailing Address - Phone:314-614-1952
Mailing Address - Fax:633-441-3262
Practice Address - Street 1:1600 HERITAGE LNDG
Practice Address - Street 2:116
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-8489
Practice Address - Country:US
Practice Address - Phone:636-345-1400
Practice Address - Fax:636-441-3262
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional