Jacilynn Cheyenne Peacock, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2022021968 Issued in MO

Practice address

2612 Annie Malone Dr
Saint Louis, MO 63113-2929

Phone

(314) 410-0522

NPI assigned

Sep 22, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Annie Malone Children and Family Service Center

  • Adolescent and Children Mental Health Clinic/Center
  • St. Louis, MO
  • NPI 1942449194
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1235852492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2612 ANNIE MALONE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631132929",
            "telephone_number": "314-531-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2612 ANNIE MALONE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631132929",
            "telephone_number": "314-410-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "JACILYNN",
        "middle_name": "CHEYENNE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2022021968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peace Haven Association
• Peace of Mind Home Health Care
• Peace of Mind Home Health Care Services LLC
• Peaceful Home Health Care LLC
• Peaceful Regions
• Crystal B Peairs, D.C.
• Meredith Peake, OTR/L
• Donna Peal-Lawson
• Pear Tree Home Care
• John Greig Pearce, MD

• Clinical Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.