MEDICARE: MS. MARLEY ANN HERZOG ACSW, 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	SW000267	MO

General Provider Information

NPI Number	:	1780895912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLEY ANN HERZOG ACSW, LCSW

Provider Business Mailing Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7802
Country	:	US
Telephone Number	:	314-602-6650
Fax Number	:	314-741-4180

Provider Business Practice Location Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7802
Country	:	US
Telephone Number	:	314-602-6650
Fax Number	:	314-741-4180

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	03/05/2014

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