Individual
MR. JERRY L. MARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DSW, LCSW
Contact information
Practice address
207 CREEKSIDE OFFICE DR, WENTZVILLE, MO 63385-3290
(636) 887-0914
(636) 206-2522
Mailing address
207 CREEKSIDE OFFICE DR, WENTZVILLE, MO 63385-3290
(636) 887-0914
(636) 206-2522
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
001120
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172616
HEALTHLINK
—
01
—
143828
BLUE CROSS
—
Enumeration date
12/21/2005
Last updated
01/06/2022
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