Facts
- Status
- A
- Credential
- LCSW
- Type
- Individual
- Enumeration date
- 2007-03-21
- Last updated
- 2026-05-17
Licenses
- License MO
- 2007007218
- License IL
- 149.028339
Location
- Practice location
- 22440 STATE HIGHWAY CC
- City
- MARBLE HILL MO
- Postal code
- 637647358
- Phone
- 573-238-5240
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.