Provider Demographics
NPI:1689552234
Name:CACOPARDO, JAMIE (PEER SUPPORT SPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CACOPARDO
Suffix:
Gender:F
Credentials:PEER SUPPORT SPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6296 JOPLIN ST
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-8404
Mailing Address - Country:US
Mailing Address - Phone:620-704-3972
Mailing Address - Fax:
Practice Address - Street 1:6296 JOPLIN ST
Practice Address - Street 2:
Practice Address - City:CARL JUNCTION
Practice Address - State:MO
Practice Address - Zip Code:64834-8404
Practice Address - Country:US
Practice Address - Phone:620-704-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20218175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty