MEDICARE: MRS. GWYNAVERE KRISTIN SCHANDER LMSW

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	104100000X	Social Worker	2012013684	MO

General Provider Information

NPI Number	:	1811324015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GWYNAVERE KRISTIN SCHANDER LMSW

Provider Business Mailing Address
First Line	:	2124 W CHESTERFIELD BLVD STE D102
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-8648
Country	:	US
Telephone Number	:	417-862-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 W CHESTERFIELD BLVD STE D102
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-8648
Country	:	US
Telephone Number	:	417-862-2273
Fax Number	:

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

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	04/15/2014

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