MEDICARE: JACKIE DEWALD

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	2014034446	MO

General Provider Information

NPI Number	:	1437563160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE DEWALD

Provider Business Mailing Address
First Line	:	8000 BONHOMME AVE STE 210
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-269-0004
Fax Number	:	314-269-0004

Provider Business Practice Location Address
First Line	:	8000 BONHOMME AVE STE 210
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-269-0004
Fax Number	:	314-269-0004

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

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	10/07/2025

Similar Medicare Providers

1033108444 — THEODORE J DEIBEL DMD
Practice Location Address:

8000 BONHOMME AVE , SUITE 422
CLAYTON, MO
63105-3515

Practice Phone: 314-725-6999
Practice Fax:

1942242227 — JAMECA WOODY COOPER PHD
Practice Location Address:

8000 BONHOMME AVE STE 206
CLAYTON, MO
63105-3515

Practice Phone: 314-502-9256
Practice Fax: 314-293-6813

1700990942 — DR. CHARLENE GOTTLIEB M.D.
Practice Location Address:

8000 BONHOMME AVE , SUITE 104
CLAYTON, MO
63105-3515

Practice Phone: 314-725-8220
Practice Fax:

1124159777 — DR. ROBERT F BERGER D.M.D.
Practice Location Address:

8000 BONHOMME AVE , SUITE 406
CLAYTON, MO
63105-3515

Practice Phone: 314-721-2113
Practice Fax: 314-721-7462

1750573960 — CHARLES BRENT MALLIN D.D.S.
Practice Location Address:

8000 BONHOMME AVE STE 401 , SUITE 401
CLAYTON, MO
63105-3515

Practice Phone: 314-727-2288
Practice Fax: 314-727-2285

1306264825 — AMY LOUISE ZIEGLER LPC
Practice Location Address:

8000 BONHOMME AVE STE 312
CLAYTON, MO
63105-3515

Practice Phone: 314-727-1903
Practice Fax:

Directions to “ JACKIE DEWALD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.