MEDICARE: JALEESA L MCCUTCHEON LMSW

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
1	104100000X	Social Worker	2024013346	MO

General Provider Information

NPI Number	:	1538990304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALEESA L MCCUTCHEON LMSW

Provider Business Mailing Address
First Line	:	3601 FRANNLYNN CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-4029
Country	:	US
Telephone Number	:	713-540-5382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 FRANNLYNN CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-4029
Country	:	US
Telephone Number	:	713-540-5382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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