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NPI Code Detail

MEDICARE: JASON DRIEDGER

MEDICARE:   JASON  DRIEDGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool PsychologistMO

General Provider Information

NPI Number : 1235724956
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON DRIEDGER
Provider Business Mailing Address
First Line : 12110 CLAYTON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63131-2516
Country : US
Telephone Number : 314-989-8150
Fax Number :
Provider Business Practice Location Address
First Line : 4531 WEBER RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-5700
Country : US
Telephone Number : 314-256-8620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2021
Last Update Date : 03/04/2021

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