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General NPI Number Information
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NPI Number | 1801281746
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Entity Type | Individual
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Provider Name | MRS. AMY KRISTINE KONSEWICZ
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Gender | Female
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 107 MISSISSIPPI AVE
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City | CRYSTAL CITY
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State | MO
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Zip | 63019-1633
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Country | US
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Telephone | 314-435-6848
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Fax |
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Provider Business Mailing Address
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Address Line | 4723 ALMA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1101
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Country | US
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Telephone | 217-836-9787
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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 | 2013017694
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License Number State | MO
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