MEDICARE: MRS. KOLLEEN L SIMONS 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	1041C0700X	Clinical Social Worker	2003000406	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265434666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KOLLEEN L SIMONS LCSW

Provider Business Mailing Address
First Line	:	9 HILLTOP VILLAGE CENTER DR
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-1106
Country	:	US
Telephone Number	:	314-374-1620
Fax Number	:	636-587-3742

Provider Business Practice Location Address
First Line	:	9 HILLTOP VILLAGE CENTER DR
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-1106
Country	:	US
Telephone Number	:	314-374-1620
Fax Number	:	636-587-3742

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/12/2010

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