Individual
JACKIE DEWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8000 BONHOMME AVE STE 210, CLAYTON, MO 63105-3515
(314) 269-0004
(314) 269-0004
Mailing address
8000 BONHOMME AVE STE 210, CLAYTON, MO 63105-3515
(314) 269-0004
(314) 269-0004
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2014034446
MO
Other
Enumeration date
06/20/2014
Last updated
10/07/2025
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