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General NPI Number Information
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NPI Number | 1275499634
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Entity Type | Individual
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Provider Name | JAMIE EWALD
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 3109 S GRAND BLVD STE 200G
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1039
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Country | US
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Telephone | 314-656-6073
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Fax |
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Provider Business Mailing Address
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Address Line | 6586 BRADLEY AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-2206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2025032141
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License Number State | MO
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