MEDICARE: MRS. SALLY J. RIGGS 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	004997	MO

General Provider Information

NPI Number	:	1679898597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY J. RIGGS L.C.S.W.

Provider Business Mailing Address
First Line	:	412 S CLAY AVE
Second Line	:	SUITE 200
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-5860
Country	:	US
Telephone Number	:	314-223-9664
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 S CLAY AVE
Second Line	:	SUITE 200
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-5860
Country	:	US
Telephone Number	:	314-223-9664
Fax Number	:

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

Provider Enumeration Date	:	04/03/2010
Last Update Date	:	04/03/2010

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