MEDICARE: MS. ALISON GRACE RICO 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	2010029938	MO

General Provider Information

NPI Number	:	1568778447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISON GRACE RICO LCSW

Provider Business Mailing Address
First Line	:	1122 COLLINGWOOD DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2412
Country	:	US
Telephone Number	:	314-629-5166
Fax Number	:

Provider Business Practice Location Address
First Line	:	6816 WASHINGTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4628
Country	:	US
Telephone Number	:	314-222-4858
Fax Number	:

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

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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