Healthcare Provider Details

I. General information

NPI: 1962698886
Provider Name (Legal Business Name): JANE M KAUZLARICH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S KIRKWOOD RD STE. 200
KIRKWOOD MO
63122-6195
US

IV. Provider business mailing address

343 S KIRKWOOD RD STE. 200
KIRKWOOD MO
63122-6195
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3441
  • Fax: 314-206-3477
Mailing address:
  • Phone: 314-206-3441
  • Fax: 314-206-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2008009617
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: