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NPI Code Detail

MEDICARE: KELLY SCHNEIDER

MEDICARE: KELLY SCHNEIDER
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
11041C0700XClinical Social Worker2008026604MO

General Provider Information

NPI Number : 1679927297
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SCHNEIDER
Provider Business Mailing Address
First Line : 1570 S MAIN ST
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4149
Country : US
Telephone Number : 636-224-1164
Fax Number :
Provider Business Practice Location Address
First Line : 1601 OLD SOUTH RIVER RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4120
Country : US
Telephone Number : 636-224-1164
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2016
Last Update Date : 11/15/2016

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