MEDICARE: GOUAUX CLINICAL ASSOC INC

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	:	1760554778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOUAUX CLINICAL ASSOC INC

Provider Business Mailing Address
First Line	:	8000 BONHOMME AVE
Second Line	:	SUITE 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	:	SUITE 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	:	OWNER
Name	:	MS. SUE M GOUAUX
Credential	:	LCSW
Telephone Number	:	314-726-0011

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	11/02/2010

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Directions to “GOUAUX CLINICAL ASSOC INC ” Practice Location

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