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General NPI Number Information
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NPI Number | 1710214762
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Entity Type | Individual
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Provider Name | REBCCA SUSAN SCHWANTES M.S.W., M.A.,
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Gender | Female
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 6614 CLAYTON RD #235
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1602
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Country | US
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Telephone | 314-361-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 6614 CLAYTON RD #235
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1602
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Country | US
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Telephone | 314-361-3530
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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 | 2009031354
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License Number State | MO
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