Provider Demographics
NPI:1235421694
Name:FENGER, MARTHA JANE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JANE
Last Name:FENGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:MARTIE
Other - Middle Name:
Other - Last Name:FENGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:13431 LAND O WOODS DR.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6027
Mailing Address - Country:US
Mailing Address - Phone:314-514-7749
Mailing Address - Fax:
Practice Address - Street 1:13431 LAND O WOODS DR.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6027
Practice Address - Country:US
Practice Address - Phone:314-514-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0008631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical