MEDICARE: MS. MELANIE BANNISH 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	1041C0700X	Clinical Social Worker	002633	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	:	1336278118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELANIE BANNISH MSW, LCSW

Provider Business Mailing Address
First Line	:	3909 MAGNOLIA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-4026
Country	:	US
Telephone Number	:	314-229-6779
Fax Number	:	314-229-6779

Provider Business Practice Location Address
First Line	:	3909A MAGNOLIA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-4026
Country	:	US
Telephone Number	:	314-229-6779
Fax Number	:	314-773-6073

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	11/02/2009

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