Provider Demographics
NPI:1033173299
Name:LOWE, JENNIFER C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:LOWE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9097
Mailing Address - Country:US
Mailing Address - Phone:816-318-1239
Mailing Address - Fax:314-640-8929
Practice Address - Street 1:412 SHOREVIEW DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9097
Practice Address - Country:US
Practice Address - Phone:816-318-1239
Practice Address - Fax:314-640-8929
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004927104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495841900Medicaid
MO164475OtherBLUE CROSS BLUE SHIELD
MO495841900Medicaid