Provider Demographics
NPI:1164463915
Name:JUETTEMEYER, BARBARA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JUETTEMEYER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MADISON AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040
Mailing Address - Country:US
Mailing Address - Phone:618-876-7515
Mailing Address - Fax:618-876-7596
Practice Address - Street 1:522 N. NEW BALLAS
Practice Address - Street 2:SUITE 332
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-989-0542
Practice Address - Fax:618-876-7596
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4740101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000078451Medicare UPIN
004740Medicare PIN