Provider Demographics
NPI:1306014428
Name:EICK-JAKIELA, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:EICK-JAKIELA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W NURSERY ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1840
Mailing Address - Country:US
Mailing Address - Phone:660-200-7000
Mailing Address - Fax:660-200-7004
Practice Address - Street 1:617 W NURSERY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1840
Practice Address - Country:US
Practice Address - Phone:660-200-7133
Practice Address - Fax:660-200-2396
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170220321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical