MEDICARE: JAMIE EWALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2025032141	MO

General Provider Information

NPI Number	:	1275499634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE EWALD

Provider Business Mailing Address
First Line	:	6586 BRADLEY AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 S GRAND BLVD STE 200G
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1039
Country	:	US
Telephone Number	:	314-656-6073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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Directions to “ JAMIE EWALD ” Practice Location

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