Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 001308 | MO |
NPI | 1003049099 |
---|---|
Provider Name | Ms. Phoebe Sue Pinkerton |
First Address | Florissant, MO 63032-0735 |
Second Address | Saint Louis, MO 63107-2928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2009 |
Last Update Date | 25/08/2009 |