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General NPI Number Information
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NPI Number | 1710217666
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Entity Type | Individual
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Provider Name | JENNIFER RENEE VORACHACK PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 12837 FLUSHING MEADOWS DR SUITE 220
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1824
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Country | US
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Telephone | 314-516-7489
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SUN VALLEY DR
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City | SAINT LOUIS
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State | MO
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Zip | 63146-5385
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Country | US
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Telephone | 417-851-7275
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2009034693
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License Number State | MO
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