| Doctor Name: | MARY E WENOM |
| NPI Number: | 1073521639 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | SW005179 |
| Business Practice Address: | 1272 Jungermann Rd Ste C Saint Peters, MO - 633766968 |
| Business Phone Number: | 6369285800 |
| Business Fax Number: | |
| Mailing Address: | 13029 Twin Meadows Ct, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631461804 |
| Phone Number: | 3144345658 |
| Fax Number: | |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 02/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW005179 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |