1760697478 NPI number — MS. JENNIFER SUZANNE STENSON MSW, LCSW

Table of content: MS. JENNIFER SUZANNE STENSON MSW, LCSW (NPI 1760697478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760697478 NPI number — MS. JENNIFER SUZANNE STENSON MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENSON
Provider First Name:
JENNIFER
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GADSKY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760697478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 COULTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKWOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122-5540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-307-0502
Provider Business Mailing Address Fax Number:
314-567-5629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9378 OLIVE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63132-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-993-7080
Provider Business Practice Location Address Fax Number:
314-567-5629
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW005815 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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