Individual
MS. MELINDA SUE KAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
517 S EUCLID AVE, SAINT LOUIS, MO 63110-1007
(314) 362-6908
(314) 747-3258
Mailing address
PO BOX 8221, 7425 FORSYTH, SAINT LOUIS, MO 63156-8221
(314) 935-0770
(314) 935-0575
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2005003884
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197032
MO-BLUE SHIELD
—
Enumeration date
07/17/2006
Last updated
07/08/2007
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