Individual
JACQUELINE LISA JACOBS-GOURTZELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1430 OLIVE ST, SUITE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
(314) 206-3708
Mailing address
1430 OLIVE ST, SUITE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2006005280
MO
Other
Enumeration date
12/13/2006
Last updated
03/07/2023
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