Provider Demographics
NPI:1972816114
Name:GILLILAND, JACQUELINE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6195
Mailing Address - Country:US
Mailing Address - Phone:314-729-4005
Mailing Address - Fax:314-729-4002
Practice Address - Street 1:343 S KIRKWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6195
Practice Address - Country:US
Practice Address - Phone:314-729-4005
Practice Address - Fax:314-729-4002
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003635171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator