=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578208575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA L DOLLAR LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2022
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 1ST CAPITOL DR STE 240
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-900-1112
-----------------------------------------------------
Fax | 888-920-1915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1078 KEYSTONE TRAIL DR
-----------------------------------------------------
City | WILDWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63005-4265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-971-4664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 10498901
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149027531
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2022010288
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------