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Individual

JACLYN MARY MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW, LSW

Contact information

Practice address
150 SAINT PETERS CENTRE BLVD STE B, SAINT PETERS, MO 63376-1653
(636) 466-8497
Mailing address
2673 RUDDY RIDGE DR, HIGH RIDGE, MO 63049-3709
(630) 818-6899

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
150.109222
IL
104100000X
Social Worker
Primary
2023013705
MO

Other

Enumeration date
04/19/2023
Last updated
04/19/2023
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