Basic Information
| Provider Information | |||||||||
| NPI: | 1487959060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SJERVEN | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HOLLY HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631112410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143535190 | ||||||||
| FaxNumber: | 3143537631 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 HOLLY HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631112410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143535190 | ||||||||
| FaxNumber: | 3143537631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | 2020021702 | MO | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.