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General NPI Number Information
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NPI Number | 1013392026
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH PACANOWSKI II MA
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Gender | Male
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 330 N GORE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63119-1600
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Country | US
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Telephone | 314-968-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 330 NORTH GORE
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City | ST. LOUIS
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State | MO
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Zip | 63119-3989
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Country | US
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Telephone | 314-919-4717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2014034451
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License Number State | MO
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