Provider Demographics
NPI:1881677524
Name:HASAK, JENNIFER K (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:HASAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ALTUS PL
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5402
Mailing Address - Country:US
Mailing Address - Phone:314-965-6311
Mailing Address - Fax:314-569-0605
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-569-0655
Practice Address - Fax:314-569-0605
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical