MEDICARE: LIFEWORK, LLC

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	1041C0700X	Clinical Social Worker	2002001381	MO

General Provider Information

NPI Number	:	1679889174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWORK, LLC

Provider Business Mailing Address
First Line	:	2055 CRAIGSHIRE RD STE 120
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4012
Country	:	US
Telephone Number	:	314-910-8608
Fax Number	:	314-392-9601

Provider Business Practice Location Address
First Line	:	1000 EXECUTIVE PARKWAY DR
Second Line	:	SUITE 120
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6325
Country	:	US
Telephone Number	:	314-910-8608
Fax Number	:	314-392-9601

Authorized Official
Title or Position	:	OWNER
Name	:	JEFF BRENNEMAN
Credential	:	LCSW
Telephone Number	:	314-910-8608

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	03/03/2021

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