Healthcare Provider Details

I. General information

NPI: 1609137793
Provider Name (Legal Business Name): ANNE L. LORNSON MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MCKELVEY RD
BRIDGETON MO
63044-2550
US

IV. Provider business mailing address

3165 MCKELVEY RD
BRIDGETON MO
63044-2550
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3436
  • Fax:
Mailing address:
  • Phone: 314-206-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: