Healthcare Provider Details

I. General information

NPI: 1770857294
Provider Name (Legal Business Name): JENNIFER J COLLIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21076 LAWRENCE 1212
ASH GROVE MO
65604-7112
US

IV. Provider business mailing address

21076 LAWRENCE 1212
ASH GROVE MO
65604-7112
US

V. Phone/Fax

Practice location:
  • Phone: 417-425-3161
  • Fax:
Mailing address:
  • Phone: 417-425-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011037834
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: