Healthcare Provider Details

I. General information

NPI: 1336058452
Provider Name (Legal Business Name): JASMIN HALLOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10733 BIG BEND RD STE 144
KIRKWOOD MO
63122-6071
US

IV. Provider business mailing address

25 MUIR ST
EUREKA MO
63025-1131
US

V. Phone/Fax

Practice location:
  • Phone: 314-742-8644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024023406
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: