Provider Demographics
NPI:1336210400
Name:KRAUSE-TAYLOR, JEANNIE KAY (MSW)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:KAY
Last Name:KRAUSE-TAYLOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 CRAIG RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7160
Mailing Address - Country:US
Mailing Address - Phone:314-395-7560
Mailing Address - Fax:314-395-7563
Practice Address - Street 1:745 CRAIG RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7160
Practice Address - Country:US
Practice Address - Phone:314-395-7560
Practice Address - Fax:314-395-7563
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0010881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO193345OtherBLUE CROSS BLUE SHIELD MO
MOP00310880OtherMEDICARE RAILROAD CARRIER
MOP00310880OtherMEDICARE RAILROAD CARRIER