Individual
MRS. GEANNETTE LOFTIN WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-7010
Mailing address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-7010
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
002651
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002651
LCSW CERT. NUMBER
MO
Enumeration date
10/12/2007
Last updated
12/18/2014
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