Individual
JACILYNN CHEYENNE PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2612 ANNIE MALONE DR, SAINT LOUIS, MO 63113-2929
(314) 410-0522
Mailing address
2612 ANNIE MALONE DR, SAINT LOUIS, MO 63113-2929
(314) 531-0120
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2022021968
MO
Other
Enumeration date
09/22/2022
Last updated
12/30/2022
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