Provider Demographics
NPI:1073227906
Name:GUIDICI, JACQUELINE (MED, PLPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GUIDICI
Suffix:
Gender:F
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 LAFAYETTE AVE
Mailing Address - Street 2:2ND FLOOR WEST
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-296-3222
Mailing Address - Fax:
Practice Address - Street 1:1804 LAFAYETTE AVE
Practice Address - Street 2:2ND FLOOR WEST
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-296-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022036659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health