MEDICARE: MS. GAIL ANN LEE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	004123	MO

General Provider Information

NPI Number	:	1144395005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL ANN LEE LCSW

Provider Business Mailing Address
First Line	:	505 RAYBURN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1609
Country	:	US
Telephone Number	:	314-909-0246
Fax Number	:	314-968-0581

Provider Business Practice Location Address
First Line	:	9051 WATSON RD
Second Line	:	SUITE 331
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2240
Country	:	US
Telephone Number	:	314-761-9157
Fax Number	:	314-968-0581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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