Healthcare Provider Details

I. General information

NPI: 1255925392
Provider Name (Legal Business Name): FLETCHER HOAGUE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 5003B
SAINT LOUIS MO
63141-8270
US

IV. Provider business mailing address

5127 PATTISON AVE
SAINT LOUIS MO
63110-2039
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6933
  • Fax: 314-251-8894
Mailing address:
  • Phone: 618-925-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: