Provider Demographics
NPI:1396381125
Name:WEIBERG, JENNIFER A (M ED, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WEIBERG
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 E CHESTNUT EXPY STE 800
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-6311
Mailing Address - Country:US
Mailing Address - Phone:417-413-4324
Mailing Address - Fax:
Practice Address - Street 1:3003 E CHESTNUT EXPY STE 800
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6311
Practice Address - Country:US
Practice Address - Phone:417-413-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000Medicaid