Healthcare Provider Details

I. General information

NPI: 1457286445
Provider Name (Legal Business Name): JEAN MELCHIOR MSW, LCSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 BERLEKAMP DR
SAINT CHARLES MO
63303-5005
US

IV. Provider business mailing address

266 BERLEKAMP DR
SAINT CHARLES MO
63303-5005
US

V. Phone/Fax

Practice location:
  • Phone: 636-634-0164
  • Fax:
Mailing address:
  • Phone: 636-634-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002006588
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: