Provider Demographics
NPI:1477783629
Name:SIEWERT, JEANINE L (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:L
Last Name:SIEWERT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:
Other - Last Name:ROHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1353 NORTH WARSON RD
Mailing Address - Street 2:PRESBYTERIAN CHILDREN'S SERVICES, INC.
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-989-9727
Mailing Address - Fax:
Practice Address - Street 1:2740 E. PYTHIAN
Practice Address - Street 2:REGIONAL GIRLS' SHELTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-862-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999135416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495363210Medicaid