Provider Demographics
NPI:1710217666
Name:VORACHACK, JENNIFER RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENEE
Last Name:VORACHACK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5385
Mailing Address - Country:US
Mailing Address - Phone:417-851-7275
Mailing Address - Fax:
Practice Address - Street 1:12837 FLUSHING MEADOWS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1824
Practice Address - Country:US
Practice Address - Phone:314-516-7489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009034693103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist