Provider Demographics
NPI:1851591523
Name:KRICK, JENNIFER DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DAWN
Last Name:KRICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10777 SUNSET OFFICE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1019
Mailing Address - Country:US
Mailing Address - Phone:314-822-5900
Mailing Address - Fax:314-822-5919
Practice Address - Street 1:6828 STATE ROUTE 162
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8500
Practice Address - Country:US
Practice Address - Phone:618-288-5084
Practice Address - Fax:618-288-8045
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2009-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005034034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036181252Medicaid