Individual
JACLYN BOLZENIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. A.
Contact information
Practice address
10560 OLD OLIVE STREET RD, SUITE 100, CREVE COEUR, MO 63141-5916
(314) 567-4707
(314) 567-4505
Mailing address
1058 TOWN AND 4 PARKWAY DR, CREVE COEUR, MO 63141-6225
(636) 697-5880
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016020606
MO
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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