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General NPI Number Information
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NPI Number | 1407703739
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Entity Type | Individual
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Provider Name | JACK KATZE
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Gender | Male
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 2310 N TRUMAN BLVD STE C
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City | CRYSTAL CITY
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State | MO
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Zip | 63019-1037
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Country | US
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Telephone | 636-232-6459
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SHERRY DR
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City | BELLEVILLE
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State | IL
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Zip | 62220-3055
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Country | US
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Telephone | 901-237-8932
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 17728
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License Number State | MO
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