Provider Demographics
NPI:1114089406
Name:POELKER, KATHY ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:POELKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MILLSTONE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2914
Mailing Address - Country:US
Mailing Address - Phone:314-280-8910
Mailing Address - Fax:636-939-0057
Practice Address - Street 1:1515 N WARSON
Practice Address - Street 2:STE 119
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-1108
Practice Address - Country:US
Practice Address - Phone:314-280-8910
Practice Address - Fax:636-939-0057
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000602101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor