Healthcare Provider Details

I. General information

NPI: 1508904749
Provider Name (Legal Business Name): RHONDA J. WURM L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FORT ZUMWALT SQ SUITE 106
O FALLON MO
63366-3078
US

IV. Provider business mailing address

59 PLACKEMEIER DR
O FALLON MO
63366-2944
US

V. Phone/Fax

Practice location:
  • Phone: 636-299-7762
  • Fax: 636-272-5738
Mailing address:
  • Phone: 636-978-4436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002562
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: