Provider Demographics
NPI:1538519723
Name:JENNEWEIN, JEANNE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:M
Last Name:JENNEWEIN
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 1:10197 ALLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2616
Mailing Address - Country:US
Mailing Address - Phone:314-805-7315
Mailing Address - Fax:
Practice Address - Street 1:10197 ALLINGTON DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2616
Practice Address - Country:US
Practice Address - Phone:314-805-7315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003644104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker