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Individual

JESSICA DOMKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC, ATR

Contact information

Practice address
12143 OLD SAINT CHARLES RD, BRIDGETON, MO 63044-2816
(314) 656-6113
Mailing address
12143 OLD SAINT CHARLES RD, BRIDGETON, MO 63044-2816
(314) 656-6113

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2022037793
MO
221700000X
Art Therapist
MO

Other

Enumeration date
11/20/2025
Last updated
11/20/2025
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