MEDICARE: MS. SUE MILBURN GOUAUX 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	000393	MO

General Provider Information

NPI Number	:	1558570804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE MILBURN GOUAUX LCSW

Provider Business Mailing Address
First Line	:	8000 BONHOMME AVE
Second Line	:	321
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-726-0011
Fax Number	:	314-721-7109

Provider Business Practice Location Address
First Line	:	8000 BONHOMME AVE
Second Line	:	321
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-726-0011
Fax Number	:	314-721-7109

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/28/2010

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