Provider Demographics
NPI:1497168785
Name:LACHAJCZYK, COLLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:LACHAJCZYK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:LACHAJCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7200 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4164
Mailing Address - Country:US
Mailing Address - Phone:314-721-8116
Mailing Address - Fax:314-721-0722
Practice Address - Street 1:7200 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4164
Practice Address - Country:US
Practice Address - Phone:314-721-8116
Practice Address - Fax:314-721-0722
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0042461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical