Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 2016013594 | MO |
NPI | 1003316449 |
---|---|
Provider Name | Erin Rachel Hendrickson |
First Address | Ballwin, MO 63021-6241 |
Second Address | Saint Louis, MO 63139-3138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 12/02/2018 |