Individual
JENA FOURAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LSCSW
Contact information
Practice address
1133 NW SOUTH SHORE DR, LAKE WAUKOMIS, MO 64151-1439
(816) 895-2533
Mailing address
1133 NW SOUTH SHORE DR, LAKE WAUKOMIS, MO 64151-1439
(816) 895-2533
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2019036298
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490083224
—
MO
Enumeration date
05/11/2020
Last updated
02/15/2023
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