MEDICARE: SIDRA KUNNEMANN-MCGUIRE M.A., LPC

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	101YP2500X	Professional Counselor	2014012335	MO

General Provider Information

NPI Number	:	1760933048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDRA KUNNEMANN-MCGUIRE M.A., LPC

Provider Business Mailing Address
First Line	:	16224 HEARTLAND LN
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-4823
Country	:	US
Telephone Number	:	573-433-6781
Fax Number	:

Provider Business Practice Location Address
First Line	:	16224 HEARTLAND LN
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-4823
Country	:	US
Telephone Number	:	573-433-6781
Fax Number	:

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

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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