MEDICARE: JESSICA CHANDLER-ZABIH LCSW

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	2016011530	MO

General Provider Information

NPI Number	:	1972126829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CHANDLER-ZABIH LCSW

Provider Business Mailing Address
First Line	:	7816 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3711
Country	:	US
Telephone Number	:	402-890-5622
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 RANCH BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-4402
Country	:	US
Telephone Number	:	501-868-6270
Fax Number	:

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

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	05/29/2020

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