MEDICARE: BRITTANIE GELLINGS ZWART 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	2013009036	MO

General Provider Information

NPI Number	:	1811402746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANIE GELLINGS ZWART LCSW

Provider Business Mailing Address
First Line	:	5921 ARSENAL ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SOVEREIGN CT STE 110
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4435
Country	:	US
Telephone Number	:	920-251-7243
Fax Number	:	920-251-7243

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

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/14/2017

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