Healthcare Provider Details

I. General information

NPI: 1558643189
Provider Name (Legal Business Name): ANN BOLLWERK SCHAD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OLIVETTE EXECUTIVE PKWY
SAINT LOUIS MO
63132-3252
US

IV. Provider business mailing address

1101 OLIVETTE EXECUTIVE PKWY
SAINT LOUIS MO
63132-3252
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-6200
  • Fax: 314-432-8894
Mailing address:
  • Phone: 314-432-6200
  • Fax: 314-432-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: