MEDICARE: ANNA WADDELL

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	1041S0200X	School Social Worker	2019043399	MO

General Provider Information

NPI Number	:	1922633734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA WADDELL

Provider Business Mailing Address
First Line	:	4431 CHOUTEAU AVE APT 1207
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4471 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1807
Country	:	US
Telephone Number	:	314-531-0982
Fax Number	:

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

Provider Enumeration Date	:	03/12/2020
Last Update Date	:	03/12/2020

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Directions to “ ANNA WADDELL ” Practice Location

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