Healthcare Provider Details

I. General information

NPI: 1659306009
Provider Name (Legal Business Name): EDWYNA MARGARET TOWLER DCSW,LCSW,MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VETERANS ADMINISTRATION MEDICAL CENTER JEFFERSON BARRACKS DIVISION
ST..LOUIS MO
63125
US

IV. Provider business mailing address

3488 EVERGREEN LN APT B
SAINT LOUIS MO
63125-4832
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-894-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: