Healthcare Provider Details

I. General information

NPI: 1689199663
Provider Name (Legal Business Name): JENNIFER WESTERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 E INDEPENDENCE AVE
INDEPENDENCE MO
64054-1511
US

IV. Provider business mailing address

430 HANNA DR
WILMINGTON NC
28412-2779
US

V. Phone/Fax

Practice location:
  • Phone: 816-836-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2015039463
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: