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General NPI Number Information
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NPI Number | 1629558044
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Entity Type | Individual
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Provider Name | KATHRYN SUE TUCKER
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1 JEFFERSON BARRACKS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4181
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Country | US
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Telephone | 143-652-4100
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Fax | 143-845-5016
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Provider Business Mailing Address
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Address Line | 3198 BROWN RD
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City | BRIGHTON
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State | IL
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Zip | 62012-2931
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Country | US
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Telephone | 186-830-5121
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Fax | 314-845-5016
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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 |
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License Number State |
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