Provider Demographics
NPI:1851802078
Name:SUCH, JENNIFER L (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SUCH
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 1:223 N MAIN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4211
Mailing Address - Country:US
Mailing Address - Phone:573-475-6534
Mailing Address - Fax:
Practice Address - Street 1:223 N MAIN ST STE 209
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-4211
Practice Address - Country:US
Practice Address - Phone:573-475-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNO NUMBERS