Healthcare Provider Details

I. General information

NPI: 1487817458
Provider Name (Legal Business Name): AMBER MELANIE AUSLANDER ACSW, LCSW, C-SSWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 CLAYTON RD CENTRAL REGION
SAINT LOUIS MO
63131-2516
US

IV. Provider business mailing address

12110 CLAYTON RD CENTRAL REGION
SAINT LOUIS MO
63131-2516
US

V. Phone/Fax

Practice location:
  • Phone: 314-616-4242
  • Fax:
Mailing address:
  • Phone: 314-616-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005733
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: