Individual
MRS. MARSHA J IVESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4218 NORTH GRAND BLVD, ST. LOUIS, MO 63107-1952
(314) 534-6624
(314) 535-4394
Mailing address
4218 N GRAND BLVD, SAINT LOUIS, MO 63107-1806
(313) 534-6624
(314) 535-4394
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16090
MO
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/28/2012
Last updated
12/22/2015
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