Healthcare Provider Details

I. General information

NPI: 1396009056
Provider Name (Legal Business Name): JAMES W GANSER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE
SAINT LOUIS MO
63117-1851
US

IV. Provider business mailing address

PO BOX 503900
SAINT LOUIS MO
63150-3900
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8610
  • Fax:
Mailing address:
  • Phone: 314-577-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005446
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: