Healthcare Provider Details

I. General information

NPI: 1659301562
Provider Name (Legal Business Name): GAFFORD GENERAL PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EXECUTIVE PARKWAY DR SUITE 120
CREVE COEUR MO
63141-6325
US

IV. Provider business mailing address

1000 EXECUTIVE PARKWAY DR SUITE 120
CREVE COEUR MO
63141-6325
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-7802
  • Fax: 314-275-7801
Mailing address:
  • Phone: 314-275-7802
  • Fax: 314-275-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2001031420
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004013906
License Number StateMO

VIII. Authorized Official

Name: DR. JENNIFER GAFFORD
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 314-275-7802