Provider Demographics
NPI:1043201833
Name:HACKLEMAN, ROBERT DEAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DEAN
Last Name:HACKLEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S BEMISTON AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1915
Mailing Address - Country:US
Mailing Address - Phone:314-540-0078
Mailing Address - Fax:314-334-0918
Practice Address - Street 1:200 S BEMISTON AVE
Practice Address - Street 2:STE 304
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1915
Practice Address - Country:US
Practice Address - Phone:314-540-0078
Practice Address - Fax:314-334-0918
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030234501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498441401Medicaid