Provider Demographics
NPI:1114612074
Name:ELY, JO REMMERT (LCSW)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:REMMERT
Last Name:ELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2844
Mailing Address - Country:US
Mailing Address - Phone:217-825-4294
Mailing Address - Fax:
Practice Address - Street 1:2206 VICTOR ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2844
Practice Address - Country:US
Practice Address - Phone:217-825-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210445971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical