MEDICARE: ELODIE ANDREWS, LCSW, LLC

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	2012028655	MO

General Provider Information

NPI Number	:	1750783221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELODIE ANDREWS, LCSW, LLC

Provider Business Mailing Address
First Line	:	9378 OLIVE BLVD STE 106
Second Line	:
City	:	OLIVETTE
State	:	MO
Zip	:	63132-3222
Country	:	US
Telephone Number	:	314-933-6587
Fax Number	:	888-975-7670

Provider Business Practice Location Address
First Line	:	9378 OLIVE BLVD STE 106
Second Line	:
City	:	OLIVETTE
State	:	MO
Zip	:	63132-3222
Country	:	US
Telephone Number	:	314-933-6587
Fax Number	:	888-975-7670

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ELODIE ANDREWS
Credential	:	LCSW
Telephone Number	:	314-933-6587

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	05/27/2020

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