MEDICARE: ERIKA DINTELMAN MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2018040368	OTHER	MO	MISSOURI DIVISION OF PROFESSIONAL ORGANIZATION

General Provider Information

NPI Number	:	1225347545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA DINTELMAN MSW, LCSW

Provider Business Mailing Address
First Line	:	1430 OLIVE ST STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2303
Country	:	US
Telephone Number	:	314-206-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	11102 LINDBERGH BUSINESS CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7810
Country	:	US
Telephone Number	:	314-206-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	11/13/2018

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