MEDICARE: KARA A DIAL 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	2017042409	MO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2017042409	MO
3	171M00000X	Case Manager/Care Coordinator	2017042409	MO

General Provider Information

NPI Number	:	1770074833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA A DIAL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 31022
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-0022
Country	:	US
Telephone Number	:	314-275-0617
Fax Number	:	314-328-5489

Provider Business Practice Location Address
First Line	:	10820 SUNSET OFFICE DR STE 220
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1030
Country	:	US
Telephone Number	:	314-275-0617
Fax Number	:

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

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	09/20/2024

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