MEDICARE: MS. PAMELA ANN LOESING MSW 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	104100000X	Social Worker	001913	MO
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1821113077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA ANN LOESING MSW LCSW

Provider Business Mailing Address
First Line	:	1508A WHISPERING CREEK DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-8484
Country	:	US
Telephone Number	:	636-225-8083
Fax Number	:

Provider Business Practice Location Address
First Line	:	983 GARDENVIEW OFFICE PARKWAY
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-5917
Country	:	US
Telephone Number	:	314-606-5176
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	11/21/2007

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