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General NPI Number Information
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NPI Number | 1033654314
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Entity Type | Individual
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Provider Name | NICOLE LANDWEHR MSW, LCSW, REAT
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Gender | Female
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 7110 OAKLAND AVE SUITE 104
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1868
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Country | US
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Telephone | 314-324-3835
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 MCKELVEY ROAD STE L PMB 1322
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City | BRIDGETON
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State | MO
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Zip | 63044-1870
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Country | US
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Telephone | 314-324-3835
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Fax | 314-552-7539
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2017040184
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License Number State | MO
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