Provider Demographics
NPI:1700597895
Name:RICE, JACKIE S (LMSW)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:S
Last Name:RICE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:S
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2012 CHERRY HILL DR STE 102B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5882
Mailing Address - Country:US
Mailing Address - Phone:573-891-1330
Mailing Address - Fax:
Practice Address - Street 1:2012 CHERRY HILL DR STE 102B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5882
Practice Address - Country:US
Practice Address - Phone:573-891-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021035211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker