Provider Demographics
NPI:1801193958
Name:CALLEN, JENNIFER LEE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:CALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 MYRLETTE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1133
Mailing Address - Country:US
Mailing Address - Phone:314-504-5646
Mailing Address - Fax:
Practice Address - Street 1:10820 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1016
Practice Address - Country:US
Practice Address - Phone:314-504-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110046301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical