Healthcare Provider Details

I. General information

NPI: 1366094039
Provider Name (Legal Business Name): COURTNEY D JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

IV. Provider business mailing address

118 N 2ND ST STE 200
SAINT CHARLES MO
63301-2894
US

V. Phone/Fax

Practice location:
  • Phone: 636-224-1000
  • Fax: 636-946-0971
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-946-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2019024749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: