Doctor Name: | MRS. WENONA H MICKAN |
NPI Number: | 1013922509 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 1085 Maple St Farmington, MO - 636401955 |
Business Phone Number: | 5737472438 |
Business Fax Number: | |
Mailing Address: | 1430 Olive St, Suite 400 SAINT LOUIS |
State: | MO |
Postal Code: | 631032303 |
Phone Number: | 5737472438 |
Fax Number: | 5737564361 |
NPI Enumeration Date: | 07/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |