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NPI Code Detail

MEDICARE: JENNIFER SEBACHER LLC

MEDICARE: JENNIFER SEBACHER LLC
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
11041C0700XClinical Social Worker002515MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558621946
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER SEBACHER LLC
Provider Business Mailing Address
First Line : 209 E ELM ST STE 11
Second Line :
City : O FALLON
State : MO
Zip : 63366-2649
Country : US
Telephone Number : 636-387-3851
Fax Number : 636-441-3923
Provider Business Practice Location Address
First Line : 21 BARTLEY ST
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2720
Country : US
Telephone Number : 636-387-3851
Fax Number : 636-441-3923
Authorized Official
Title or Position : CLINICAL THERAPIST
Name : JENNIFER L SEBACHER
Credential : LCSW
Telephone Number : 636-387-3851
Provider Enumeration Date : 05/21/2012
Last Update Date : 05/21/2012

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Directions to “JENNIFER SEBACHER LLC ” Practice Location

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