Provider Demographics
NPI:1720313596
Name:BODILY, JAMIE KAY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KAY
Last Name:BODILY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BURGUNDY LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4108
Mailing Address - Country:US
Mailing Address - Phone:636-699-2839
Mailing Address - Fax:
Practice Address - Street 1:1480 WOODSTONE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-6869
Practice Address - Country:US
Practice Address - Phone:636-699-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MO2013041574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374J00000XNursing Service Related ProvidersDoula