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General NPI Number Information
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NPI Number | 1689100083
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Entity Type | Individual
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Provider Name | JENNIFER SEDLACEK FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 1250
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1263
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Country | US
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Telephone | 636-939-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone | 216-468-5000
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209016337
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2017027608
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License Number State | MO
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