Individual
MRS. IDA JANE GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
12755 OLIVE BLVD STE 115, SUITE 115, SAINT LOUIS, MO 63141-6242
(314) 898-0100
(314) 371-6508
Mailing address
4666 KELLYKRIS DR, SAINT CHARLES, MO 63304-3411
(636) 936-2466
(314) 371-6508
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101Y00000X
MO
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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