Basic Information
| Provider Information | |||||||||
| NPI: | 1356497366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORTH | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 OLIVE ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631032303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142063700 | ||||||||
| FaxNumber: | 3142063708 | ||||||||
| Practice Location | |||||||||
| Address1: | 3165 MCKELVEY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142063900 | ||||||||
| FaxNumber: | 3142063992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.