Individual
KELLEE VIRGINIA POTTHAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1723A NICHOLSON PL, SAINT LOUIS, MO 63104-2662
(314) 287-0097
Mailing address
1723A NICHOLSON PL, SAINT LOUIS, MO 63104-2662
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2019018464
MO
Other
Enumeration date
01/12/2020
Last updated
01/12/2020
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