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NPI Code Detail

MEDICARE: MARTHA LEDYARD

MEDICARE: MARTHA LEDYARD
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
11041C0700XClinical Social WorkerSW000352MO

General Provider Information

NPI Number : 1932252129
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA LEDYARD
Provider Business Mailing Address
First Line : 5351 DELMAR BLVD
Second Line : MAILSTOP 17
City : SAINT LOUIS
State : MO
Zip : 63112-3146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1901 PENNSYLVANIA AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1325
Country : US
Telephone Number : 314-877-0589
Fax Number : 314-877-0575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 07/08/2007

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Directions to “ MARTHA LEDYARD ” Practice Location

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