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General NPI Number Information
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NPI Number | 1760997159
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Entity Type | Organization
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Legal Business Name | DAWN GROSS LLC
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 11042 MANCHESTER RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-1244
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Country | US
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Telephone | 844-462-3492
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Fax |
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Provider Business Mailing Address
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Address Line | 911 GROVENA DR
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAWN GROSS
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Credential | MSW, LCSW
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Telephone | 636-368-7655
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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 | 2017037199
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License Number State | MO
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