Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2008020381 | MO |
NPI | 1003128448 |
---|---|
Provider Name | Susan Gilmor |
First Address | Saint Louis, MO 63131-1858 |
Second Address | Saint Louis, MO 63131-1858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 13/07/2010 |