MEDICARE: KATHLEEN A HUMMEL L.C.S.W.

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	003593	MO

General Provider Information

NPI Number	:	1568665974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A HUMMEL L.C.S.W.

Provider Business Mailing Address
First Line	:	4316 LINDELL BLVD
Second Line	:	OUR LITTLE HAVEN
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2702
Country	:	US
Telephone Number	:	314-533-2229
Fax Number	:	314-533-3098

Provider Business Practice Location Address
First Line	:	4316 LINDELL BLVD
Second Line	:	OUR LITTLE HAVEN
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2702
Country	:	US
Telephone Number	:	314-533-2229
Fax Number	:	314-533-3098

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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Directions to “ KATHLEEN A HUMMEL L.C.S.W.” Practice Location

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