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NPI Code Detail

MEDICARE: JENNIFER LOUISE NELSON MA

MEDICARE: JENNIFER LOUISE NELSON MA
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
1101YP2500XProfessional Counselor2026013907MO
2101Y00000XCounselor
3171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IMF81155OTHERCABOARD OF BEHAVIORAL SCIENCE - MARIAGE AND FAMILY THERAPIST INTERN

General Provider Information

NPI Number : 1710388079
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LOUISE NELSON MA
Provider Business Mailing Address
First Line : 1430 OLIVE ST STE 400
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-2303
Country : US
Telephone Number : 314-206-3700
Fax Number :
Provider Business Practice Location Address
First Line : 1085 MAPLE ST
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-1955
Country : US
Telephone Number : 573-756-5353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2014
Last Update Date : 05/13/2026

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Directions to “ JENNIFER LOUISE NELSON MA” Practice Location

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