Healthcare Provider Details

I. General information

NPI: 1891939773
Provider Name (Legal Business Name): JENNIFER LEIGH ALBRACHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HAMPTON AVE
SAINT LOUIS MO
63139-2908
US

IV. Provider business mailing address

2301 HAMPTON AVE
SAINT LOUIS MO
63139-2908
US

V. Phone/Fax

Practice location:
  • Phone: 888-657-3201
  • Fax: 314-781-3295
Mailing address:
  • Phone: 888-657-3201
  • Fax: 314-781-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2007017151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: