Organization
GREAT CIRCLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN RENEE KLIETHERMES (CREDENTIALING SPECIALIST)
(573) 303-7219
Entity
Organization
Contact information
Practice address
330 N GORE AVE, SAINT LOUIS, MO 63119-1600
(314) 968-2060
(314) 968-8308
Mailing address
PO BOX 189, SAINT JAMES, MO 65559-0189
(573) 265-3251
(573) 265-5370
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
—
1041S0200X
School Social Worker
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
11/27/2018
Last updated
12/04/2018
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