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General NPI Number Information
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NPI Number | 1093092413
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Entity Type | Organization
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Legal Business Name | PAMELA JEAN WEBER
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 9890 CLAYTON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-452-1529
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Fax |
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Provider Business Mailing Address
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Address Line | 9890 CLAYTON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-452-1529
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MS. PAMELA JEAN WEBER
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Credential | LCSW
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Telephone | 314-452-1529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 2011035620
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License Number State | MO
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