Individual
MS. FANNIE RODGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11018 WORCHESTER DR, SAINT LOUIS, MO 63136-5829
(314) 355-4337
Mailing address
11018 WORCHESTER DR, SAINT LOUIS, MO 63136-5829
(314) 355-4337
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
002631
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493514525
—
MO
Enumeration date
07/17/2007
Last updated
07/17/2007
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