Individual
GINA NICOLE BAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
261 BLESS US DR E, WENTZVILLE, MO 63385-2227
(636) 577-4607
Mailing address
261 BLESS US DR E, WENTZVILLE, MO 63385-2227
(636) 577-4607
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2009010546
MO
Other
Enumeration date
06/03/2009
Last updated
06/01/2011
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