Provider Demographics
NPI:1851889281
Name:DERNER, JENNIFER M (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DERNER
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 1:9051 WATSON RD #134
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2220
Mailing Address - Country:US
Mailing Address - Phone:314-328-5701
Mailing Address - Fax:314-408-8400
Practice Address - Street 1:128 OAK TREE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4760
Practice Address - Country:US
Practice Address - Phone:314-328-5701
Practice Address - Fax:314-408-8400
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 174H00000X, 174H00000X
MO0050641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174H00000XOther Service ProvidersHealth Educator