Healthcare Provider Details

I. General information

NPI: 1881083418
Provider Name (Legal Business Name): MARY SAGGAU MSW LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 LOUGHMOR PASS
WELDON SPRING MO
63304-0506
US

IV. Provider business mailing address

623 LOUGHMOR PASS
WELDON SPRING MO
63304-0506
US

V. Phone/Fax

Practice location:
  • Phone: 314-974-7040
  • Fax:
Mailing address:
  • Phone: 314-974-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006006911
License Number StateMO

VIII. Authorized Official

Name: MS. MARY GRACE SAGGAU
Title or Position: OWNER
Credential: LCSW
Phone: 314-974-7040