Healthcare Provider Details

I. General information

NPI: 1710695036
Provider Name (Legal Business Name): JESSALYN WININGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BOONES LICK RD
SAINT CHARLES MO
63301-2247
US

IV. Provider business mailing address

9 LOST MEADOW CT
WINFIELD MO
63389-3255
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-5600
  • Fax:
Mailing address:
  • Phone: 636-358-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020029061
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: