MEDICARE: JAMIE KAY BODILY MS, LPC

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	374J00000X	Doula
2	101YP2500X	Professional Counselor	2013041574	MO

General Provider Information

NPI Number	:	1720313596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE KAY BODILY MS, LPC

Provider Business Mailing Address
First Line	:	1100 BURGUNDY LN
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4108
Country	:	US
Telephone Number	:	636-699-2839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 WOODSTONE DR
Second Line	:	SUITE 112
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-6869
Country	:	US
Telephone Number	:	636-699-2839
Fax Number	:

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

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	01/15/2016

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