MEDICARE: MARGARET YERKES KILLEEN

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	101YP2500X	Professional Counselor	2011008961	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2011008961	OTHER	MO	STATE OF MISSOURI

General Provider Information

NPI Number	:	1306500855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET YERKES KILLEEN

Provider Business Mailing Address
First Line	:	144 SLOCUM AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2254
Country	:	US
Telephone Number	:	314-560-9970
Fax Number	:

Provider Business Practice Location Address
First Line	:	6744 CLAYTON RD STE 221
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1634
Country	:	US
Telephone Number	:	314-720-2710
Fax Number	:

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

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	10/29/2021

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