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General NPI Number Information
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NPI Number | 1396231007
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Entity Type | Individual
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Provider Name | ELYSE VESSER MSW
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 3250 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-2379
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Country | US
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Telephone | 314-531-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 COLUMBIA AVE # 1E
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1014
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Country | US
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Telephone | 636-751-8486
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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