Healthcare Provider Details

I. General information

NPI: 1730726852
Provider Name (Legal Business Name): AMANDA THIEME LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT STE 103
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

5203 SHETLAND DR
WELDON SPRING MO
63304-7592
US

V. Phone/Fax

Practice location:
  • Phone: 314-441-6977
  • Fax:
Mailing address:
  • Phone: 314-596-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017024103
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: