Healthcare Provider Details

I. General information

NPI: 1710492889
Provider Name (Legal Business Name): BETSY W SCHLUETER-BRANNAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETSY W SCHLUETER LCSW

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 EAGLE CREST LN
ST. CHARLES MO
63303-3742
US

IV. Provider business mailing address

14 EAGLE CREST LN
SAINT CHARLES MO
63303-3742
US

V. Phone/Fax

Practice location:
  • Phone: 314-313-0898
  • Fax:
Mailing address:
  • Phone: 314-313-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001367
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: