Provider Demographics
NPI:1407089022
Name:WILSON, JENNIE LEIGH (MA, LPC, NCC, RPT-S)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:LEIGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC, RPT-S
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2081 COLLIER CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6701
Mailing Address - Country:US
Mailing Address - Phone:636-255-0002
Mailing Address - Fax:636-634-4777
Practice Address - Street 1:2081 COLLIER CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6701
Practice Address - Country:US
Practice Address - Phone:636-255-0002
Practice Address - Fax:636-634-4777
Is Sole Proprietor?:No
Enumeration Date:2009-08-30
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2009012843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional