MEDICARE: VIRGINIA A IVES LCSW, MSW,ACSW MAED,

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	000112	MO

General Provider Information

NPI Number	:	1497805915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA A IVES LCSW, MSW,ACSW MAED,

Provider Business Mailing Address
First Line	:	14335 CROSS TIMBERS CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-5718
Country	:	US
Telephone Number	:	314-878-5346
Fax Number	:	314-878-7434

Provider Business Practice Location Address
First Line	:	1200 S LINDBERGH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2923
Country	:	US
Telephone Number	:	314-432-7927
Fax Number	:	314-991-1242

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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