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NPI Code Detail

MEDICARE: MR. MARY ALICE LADUKE

MEDICARE: MR. MARY ALICE LADUKE
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
11041C0700XClinical Social Worker2000175587MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1540227OTHERHEALTHLINK
2155753OTHERBLUE CROSS

General Provider Information

NPI Number : 1245216217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARY ALICE LADUKE
Provider Business Mailing Address
First Line : 9200 WATSON RD
Second Line : SUITE G101
City : SAINT LOUIS
State : MO
Zip : 63126-1528
Country : US
Telephone Number : 314-367-5500
Fax Number : 314-843-9212
Provider Business Practice Location Address
First Line : 9200 WATSON RD
Second Line : SUITE G101
City : SAINT LOUIS
State : MO
Zip : 63126-1528
Country : US
Telephone Number : 314-367-5500
Fax Number : 314-843-9212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 07/08/2007

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Directions to “ MR. MARY ALICE LADUKE ” Practice Location

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