Individual
KYLIE MANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, PLPC
Contact information
Practice address
330 N GORE AVE, SAINT LOUIS, MO 63119-1600
(314) 919-4768
Mailing address
330 NORTH GORE AVENUE, ST. LOUIS, MO 63119
(314) 919-4768
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2012008956
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
430681471
—
MO
Enumeration date
10/10/2013
Last updated
10/10/2013
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