Healthcare Provider Details

I. General information

NPI: 1912817941
Provider Name (Legal Business Name): JACQUELINE NICOLE JOZEFKOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW BAYTREE DR
GRAIN VALLEY MO
64029-7316
US

IV. Provider business mailing address

1001 NW BAYTREE DR
GRAIN VALLEY MO
64029-7316
US

V. Phone/Fax

Practice location:
  • Phone: 816-622-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2023038882
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: