Individual
MS. MAXINE BIRDSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
18 SOUTH KINGS HIGHWAY, SAINT LOUIS, MO 63108-2103
(314) 367-2010
Mailing address
4579 LACLEDE AVENUE, SAINT LOUIS, MO 63108-2103
(314) 367-2010
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002499
STATE OF MISSOURI
MO
Enumeration date
04/02/2007
Last updated
07/08/2007
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