Basic Information
Provider Information
NPI: 1417003492
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHNEIDER
FirstName: TERESA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1430 OLIVE ST
Address2: SUITE 400
City: SAINT LOUIS
State: MO
PostalCode: 631032303
CountryCode: US
TelephoneNumber: 3142063700
FaxNumber: 3142063708
Practice Location
Address1: 343 S KIRKWOOD RD
Address2: SUITE 200
City: SAINT LOUIS
State: MO
PostalCode: 631226195
CountryCode: US
TelephoneNumber: 3142063400
FaxNumber: 3142063477
Other Information
ProviderEnumerationDate: 01/25/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X  Y Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home