Healthcare Provider Details

I. General information

NPI: 1144660473
Provider Name (Legal Business Name): JASON ECCKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 MACKLIND AVE
SAINT LOUIS MO
63139-1406
US

IV. Provider business mailing address

3232 CLIFTON AVE UNIT 5177
SAINT LOUIS MO
63139-4004
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-0174
  • Fax: 314-219-4591
Mailing address:
  • Phone: 314-252-0174
  • Fax: 314-219-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2014004402
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: