Healthcare Provider Details

I. General information

NPI: 1679351738
Provider Name (Legal Business Name): ERICA M SANDERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LYNCH ST
SAINT LOUIS MO
63118-1818
US

IV. Provider business mailing address

1501 MENDELL DR
SAINT LOUIS MO
63130-1215
US

V. Phone/Fax

Practice location:
  • Phone: 314-535-5600
  • Fax:
Mailing address:
  • Phone: 314-520-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023037356
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: