Healthcare Provider Details

I. General information

NPI: 1023733060
Provider Name (Legal Business Name): LEENA A WAHBA LCSW : 2021047161
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N JEFFERSON AVE
SAINT LOUIS MO
63103-3000
US

IV. Provider business mailing address

515 N JEFFERSON AVE
SAINT LOUIS MO
63103-3000
US

V. Phone/Fax

Practice location:
  • Phone: 314-728-0033
  • Fax: 314-289-6543
Mailing address:
  • Phone: 314-728-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021047161
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: