Provider Demographics
NPI:1679941512
Name:WALSMA, JANE (LCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:WALSMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2516
Mailing Address - Country:US
Mailing Address - Phone:636-923-3654
Mailing Address - Fax:636-225-4518
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1573
Practice Address - Country:US
Practice Address - Phone:636-923-3654
Practice Address - Fax:636-225-4518
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0046791041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool