Healthcare Provider Details

I. General information

NPI: 1891142311
Provider Name (Legal Business Name): JEREMY HODESS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 COUNTRY OAK DR
CHESTERFIELD MO
63017-2822
US

IV. Provider business mailing address

414 COUNTRY OAK DR
CHESTERFIELD MO
63017-2822
US

V. Phone/Fax

Practice location:
  • Phone: 314-974-5524
  • Fax:
Mailing address:
  • Phone: 314-201-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002014228
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25547
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW126602
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928083
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: