Individual
MRS. SUSIE DIETZ MCGAUGHEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, PLPC
Contact information
Practice address
330 N GORE AVE, SAINT LOUIS, MO 63119-1600
(314) 968-2060
Mailing address
330 N GORE AVE, SAINT LOUIS, MO 63119-1600
(314) 968-2060
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
178.005558
IL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
2008014718
MO
Other
Enumeration date
06/25/2008
Last updated
06/25/2008
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