Healthcare Provider Details

I. General information

NPI: 1669629523
Provider Name (Legal Business Name): JENNIFER M NAHM MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W KIRKHAM AVE
WEBSTER GROVES MO
63119-2233
US

IV. Provider business mailing address

602 W KIRKHAM AVE
WEBSTER GROVES MO
63119-2233
US

V. Phone/Fax

Practice location:
  • Phone: 636-375-1285
  • Fax: 314-963-9047
Mailing address:
  • Phone: 636-375-1285
  • Fax: 314-963-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2009035824
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: