Provider Demographics
NPI:1588340889
Name:POPPE, JENNA WOOD
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:WOOD
Last Name:POPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 CARMAN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8013
Mailing Address - Country:US
Mailing Address - Phone:214-531-0554
Mailing Address - Fax:
Practice Address - Street 1:2001 S HANLEY RD STE 195
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1520
Practice Address - Country:US
Practice Address - Phone:314-252-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health