Provider Demographics
NPI:1942259809
Name:GAFFORD, JENNIFER SW (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SW
Last Name:GAFFORD
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 1:401 HOLLY HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2410
Mailing Address - Country:US
Mailing Address - Phone:314-353-5190
Mailing Address - Fax:314-353-7631
Practice Address - Street 1:401 HOLLY HILLS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2410
Practice Address - Country:US
Practice Address - Phone:314-353-5190
Practice Address - Fax:314-353-7631
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031420103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496072703Medicaid