Provider Demographics
NPI:1043550965
Name:MEMHARDT, KAREN L (MAED PLPC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:MEMHARDT
Suffix:
Gender:F
Credentials:MAED PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BEACON POINT LN
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1810
Mailing Address - Country:US
Mailing Address - Phone:314-614-5079
Mailing Address - Fax:
Practice Address - Street 1:930 KEHRS MILL RD
Practice Address - Street 2:SUITE 325-1
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2462
Practice Address - Country:US
Practice Address - Phone:314-614-5079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041725101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)